ASGE Annual Postgraduate Course Endoscopy 2022: Breakthrough to Excellence | DDW 2022-Prateek_Reducing Post Endoscopy Barretts Neoplasia

Prateek_Reducing Post Endoscopy Barretts Neoplasia

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This document discusses the concept of Post-Endoscopic Barrett's Neoplasia (PEBN), which refers to the detection of Barrett's neoplasia after a negative endoscopy. The relevance of PEBN lies in the increasing incidence of esophageal adenocarcinoma (EAC) with a poor prognosis. Early detection of precursor lesions can prevent the progression to EAC. Studies have shown that around 25% of EACs are diagnosed within a year of a negative endoscopy, highlighting the need for standardized definitions and improved detection methods.<br /><br />The majority of neoplasia cases are detected at the index endoscopy. A systematic review and meta-analysis found that the neoplasia detection rate (NDR), which refers to the percentage of Barrett's esophagus (BE) patients with neoplasia (high-grade dysplasia or cancer) on the index endoscopy, is important in determining the prevalence of neoplasia. Prevalent BE neoplasia is increasing, with studies showing a rising trend in the detection of low-grade dysplasia, high-grade dysplasia, and EAC in BE patients.<br /><br />Improving NDR requires performing high-quality endoscopy, including adequate biopsy sampling, careful mucosal examination, and appropriate recognition of neoplastic lesions. Techniques such as white light endoscopy, Barrett's inspection time (BIT), and 4 quadrant biopsies can help improve NDR. Virtual chromoendoscopy is another technique that can enhance neoplasia detection.<br /><br />Educational interventions, such as the AQUIRE RCT study, have shown promising results in improving BE detection rates. Proposed quality metrics for BE surveillance include the percent of routine surveillance with sufficient inspection time per cm of circumferential BE and the percent detection of dysplasia on index endoscopy.<br /><br />In conclusion, understanding PEBN and NDR is crucial, and performing a high-quality examination is critical in reducing PEBN. Neoplasia may be missed at the index endoscopy, emphasizing the importance of early recognition and treatment to improve patient outcomes.

Keywords

Post-Endoscopic Barrett's Neoplasia

esophageal adenocarcinoma

precursor lesions

standardized definitions

neoplasia detection rate

low-grade dysplasia

high-grade dysplasia

white light endoscopy

AQUIRE RCT study

BE surveillance