ASGE Annual Postgraduate Course Endoscopy 2022 (On-Demand): Breakthrough to Excellence-Prateek_Reducing Post Endoscopy Barretts Neoplasia

Prateek_Reducing Post Endoscopy Barretts Neoplasia

Pdf Summary

Post-endoscopic Barrett's neoplasia (PEBN) refers to the detection of Barrett's neoplasia after a negative endoscopy. This is significant because the incidence of esophageal adenocarcinoma (EAC) is increasing and has a poor 5-year prognosis. Identifying precursor lesions of Barrett's esophagus (BE) early can prevent the progression to EAC. It has been found that around 25% of EACs are diagnosed within a year of a negative index endoscopy. However, standardized definitions for PEBN are lacking.<br /><br />Most cases of neoplasia are detected during the initial endoscopy. A systematic review and meta-analysis of 11 studies with nearly 60,000 patients found that the neoplasia detection rate (NDR) among BE patients on index endoscopy varies. Improving the NDR is important to identify and treat neoplastic lesions early. This can be achieved through high-quality endoscopy, adequate biopsy sampling, careful mucosal examination, and appropriate recognition of neoplastic lesions.<br /><br />Improving the NDR can be facilitated by performing high-quality endoscopy, which includes thorough mucosal examination and adequate biopsy sampling. Techniques such as white light endoscopy, Barrett's inspection time (BIT), and 4 quadrant biopsies can help enhance detection. Additionally, virtual chromoendoscopy has shown promise in improving the NDR.<br /><br />Educational interventions, such as the Acquire RCT, have also been effective in improving BE detection. Compliance with the Seattle biopsy protocol is an important quality metric. Proposed quality metrics for BE include the percentage of routine BE surveillance with sufficient inspection time per cm of circumferential BE and the percent detection of dysplasia on index endoscopy screening for BE.<br /><br />In conclusion, understanding PEBN and the NDR is crucial. Performing high-quality endoscopy and improving detection techniques can help reduce PEBN. Identifying neoplasia early and providing timely treatment will lead to better patient outcomes.

Keywords

Post-endoscopic Barrett's neoplasia

Barrett's esophagus

Esophageal adenocarcinoma

Neoplasia detection rate

High-quality endoscopy

Adequate biopsy sampling

Mucosal examination

Neoplastic lesions

Virtual chromoendoscopy

Seattle biopsy protocol