Perception of High Esophageal Cancer (EC) Risk is Associated With Decreased Quality of Life (QOL) in Patients With Barrett's Esophagus (BE)

Abstract

visible lesions, 3) patients with HGD/EAC, and 4) number of HGD/EAC areas Methods: Data from a prospective, multi-center, randomized controlled trial evaluating the role of novel imaging techniques [High Definition White Light Endoscopy (HD-WLE), narrow band imaging (NBI), and probe based confocal endomicroscopy (pCLE)] were reviewed. As part of the protocol, coordinators at each study site recorded the time spent inspecting the BE mucosa using HD-WLE (Olympus 180 HD, with clear cap, no magnification) using a stop watch prior to biopsies being obtained. All visible lesions were described using the Paris classification system. To determine each patient's final histologic diagnosis, every patient was examined with HD-WLE, NBI, and pCLE. All suspicious areas as well as four quadrant random locations were biopsied then reviewed by a central pathologist. Fisher's exact test and an unpaired t-test were used to compare categorical and continuous variables, respectively. Results: 112 patients (mean age 65.5; 83.9% men, 100% Caucasian) with a mean BE length of 3.7cm were enrolled. The mean BIT with HD-WLE was 3.8min (SD 2.5min). 57 patients had a visible lesion seen on HD-WLE examination and 38 patients had a final diagnosis of HGD/EAC. Patients with a BIT with HD-WLE < 5 min were less likely to have a visible lesion (32.4% vs. 82.9%, p<0.001) and less likely to have a final diagnosis of HGD/ EAC (22.5% vs. 53.7%, p=0.002) compared to patients with a BIT ≥ 5 min. In addition, patients with a BIT of < 5 min had fewer visible lesions (0.51 vs. 1.95, p<0.0001) and fewer areas with HGD/Ca (0.51 vs. 2.29, p=0.004). This was despite no significant difference in mean BE length between patients with BIT < 5 and ≥ 5 min (3.3cm vs. 4.4cm, p=0.11). When patients with Paris I and III lesions were excluded, patients with a BIT < 5 minutes were still less likely to have a visible lesion (29.4% vs. 79.4%, p<0.001) less likely to have a final diagnosis of HGD/EAC (19.1% vs. 50.0%, p=0.002), had fewer visible lesions (0.43 vs. 1.82, p<0.0001), and had fewer areas with HGD/EAC (0.45 vs. 1.91, p=0.003). Conclusion: A longer inspection time of the BE mucosa is associated with a higher rate of detection of endoscopically visible lesions, patients with HGD/EAC, and areas with HGD/EAC. Endoscopists practicing BE surveillance should spend on average approximately 1 min per cm of BE using HD-WLE prior to obtaining biopsies.