Mo1923 Non-Dysplastic Barrett's Esophagus Is Not Created the Same: Genetic Abnormalities in Non-Dysplastic Barrett's Esophagus Are Dependent on Clinical Context

Abstract

academic based practices. 90% required intestinal metaplasia for the diagnosis of Barrett's esophagus. Only 67% were aware of the Prague classification, which was used by 53% of those aware of it. The annual risk of progression to esophageal adenocarcinoma was reported as 0.1-0.5% by 76% of respondents, but was reported as . 5% per year by 14%. Screening practices were highly variable, with 35% screening all patients with chronic GERD symptoms regardless of gender or age, 27% reserving screening for age . 50yrs, and 31% screening those with multiple risk factors associated with Barrett's esophagus. 85% of respondents did not offer repeat screening after an initial negative EGD whereas repeated screening for Barrett's after a negative examination was performed by 10% after 3-5 years. 14% performed biopsies of a normal appearing Z-line. Surveillance for non-dysplastic Barrett's was performed at 3-5 year intervals by 79%. Electronic chromoendoscopy was the only widely used advanced imaging modality, reported by 60%, whereas , 1% used confocal endomicroscopy. Four quadrant biopsies at 2 cm intervals were done by 77% for non-dysplastic Barrett's and at 1 cm intervals by 76% for dysplastic Barrett's. Histopathological confirmation of dysplasia was reported by 86%. See Table for additional details. Conclusions: Among respondents, we observed that there is excellent adherence to the new AGA Barrett's esophagus guidelines in general, particularly in the areas of diagnosis and cancer risk estimates, but there are some notable exceptions. Considerable variability exists in terms of 1) identifying risk factors for screening, 2) timing of surveillance intervals, and 3) use of the Prague classification. Reasons underlying the continued variability in adherence to Barrett's practice guidelines merit further study. Table 1. Diagnostic, screening, and surveillance practices