Management of Barrett’s high-grade dysplasia: initial results from a population-based national audit

详细信息    查看全文

• 作者：Georgina Chadwick ; MRCP¹ ; ² ; ; Oliver Groene ; PhD¹ ; ³ ; Angelina Taylor ; MSc¹ ; Stuart Riley ; MRCP⁴ ; Richard H. Hardwick ; MD⁵ ; Tom Crosby ; MRCP ; FRCR⁶ ; Kimberley Greenaway⁷ ; David A. Cromwell ; PhD¹ ; ³
• 关键词：BE ; Barrett&rsquo ; s esophagus ; BSG ; British Society of Gastroenterologists ; ESD ; endoscopic submucosal dissection ; HGD ; high-grade dysplasia ; MDT ; multidisciplinary team ; NHS ; National Health Service ; NOGCA ; National Oesophago-Gastric Cancer Audit ; RFA ; radiofrequency ablation
• 刊名：Gastrointestinal Endoscopy
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：83
• 期：4
• 页码：736-742.e1
• 全文大小：196 K

文摘

Previous studies reported significant variation in the management of patients with Barrett’s esophagus. However, these are based on self-reported clinical practice. The aim of this study was to examine the management of high-grade dysplasia in Barrett’s esophagus in England by using patient-level data and to compare practice with guidelines.

Methods

From April 2012 to March 2013, National Health Service (NHS) trusts in England prospectively collected data on patients newly diagnosed with high-grade dysplasia (HGD) of the esophagus as part of the National Oesophago-Gastric Cancer Audit. Data were collected on patient characteristics, diagnosis and endoscopic findings, treatment planning, and therapy.

Results

Between April 2012 and March 2013, NHS trusts reported 465 cases of HGD. Diagnosis was confirmed by a second pathologist in 79.4% of cases (270/340), and 86.0% (374/465) had their treatment planned at a multidisciplinary team meeting. A total of 290 patients (62.4%) were managed endoscopically (frequently with endoscopic resection or radiofrequency ablation), whereas 26 patients (5.6%) had esophagectomy. The proportion of patients managed by surveillance varied by age (P < .001), ranging from 19.5% in patients aged <65 years to 63.8% in patients aged ≥85 years. More patients received active treatment if their cases were discussed at a multidisciplinary meeting (73.5% vs 44.3%; P < .001) or managed at higher-volume trusts (87.8% vs 55.4%; P < .001).

Conclusions

There was marked variation in the management of HGD across England, with a third of patients receiving no active treatment. Patients discussed at a specialist multidisciplinary meeting or managed in high-volume trusts were more likely to receive active treatment.