Dedicated endoscopy for Barrett’s esophagus randomized blinded pilot study: comparing a dedicated Barrett’s surveillance service with standard care

Abstract

Background and aimsBarrett’s esophagus endoscopic surveillance is prone to poor guideline adherence. This study was undertaken to obtain pilot data comparing standard care with a dedicated Barrett’s endoscopy service. MethodsAdults with non-dysplastic Barrett’s esophagus at two sites in the Northwest of England were randomized to a dedicated service versus a non-dedicated service for their routine surveillance. On the dedicated arm 64% were male, 72% non-dedicated with median ages of 66years and 63years and mean Prague C length of 2cms and 3cms respectively. The dedicated service was performed by endoscopists trained in Barrett’s assessment on specific sessions. Data were obtained on dysplasia detection and adherence to British Society of gastroenterology guidelines. ResultsOf 112 recruited cases (80% recruitment rate), 92 had endoscopy of which 39 were correctly performed on the dedicated arm and 25 on the non-dedicated arm. In the dedicated arm 5/39(13%) cases of dysplasia were found, and2/25 (8%) cases in the non-dedicated arm. Guideline adherence was better in the dedicated arm, particularly Prague classification documentation (37/39, 95%, versus 20/25, 80%) and Seattle protocol adherence (34/39, 87% versus 15/25, 60%). Post-hoc analysis with χ2 showed improved Seattle protocol adherence (34/37 dedicated vs 15/24 non dedicated, p=0.005), visible lesion documentation (37/38 dedicated vs 12/23 non-dedicated, p=<0.001), and use of targeted biopsies (25/39 dedicated vs 3/25 non-dedicated (p=<0.001). ConclusionsThis study is the first pilot randomized trial of dedicated services versus non-dedicated services for Barrett’s surveillance. It shows the study design is feasible and informs a future powered multicenter study.