Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
Copyright © 2018 Korean Society of Gastrointestinal Endoscopy
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflicts of Interest:This work was supported by the University of Colorado, Department of Medicine Outstanding Early Scholars Program (SW) and NIH T32DK007038-42 (SH). Consultant – Medtronic, Boston Scientific (SW).
BE, Barrett’s esophagus. Adapted with permission from Sharma et al. [4]
GI, gastrointestinal; EET, endoscopic eradication therapy; HD-WLE, high-definition white light endoscopy; EMR, endoscopic mucosal resection; N/A, not available; CE-IM, complete eradication of intestinal metaplasia. Reprinted with permission from Wani et al. [6]
Quality indicator | Agreement | Grade of recommendation |
---|---|---|
Screening, diagnosis, and staging | ||
For patients in whom BE is suspected, the squamo-columnar junction, the gastroesophageal junction, and the location of the diaphragmatic hiatus (if there is a hiatal hernia present) should be recorded on each upper endoscopy | 87% (35% strongly agree, 52% agree) | Weak |
If BE is suspected on endoscopy, the endoscopist should document the extent of suspected BE using the Prague criteria | 82.6% (43.5% strongly agree, 39.1% agree) | Weak |
Surveillance | ||
If systematic surveillance biopsies performed in a patient known to have BE show no evidence of dysplasia, follow-up surveillance endoscopy should be recommended no sooner than 3 to 5 years | 91.3% (17.3% strongly agree, 74% agree) | Weak |
If a patient with known BE undergoes surveillance endoscopy, systematic biopsies should be taken every 1–2 cm from 4 quadrants throughout the extent of the endoscopically involved segment | 95.7% (52.2% strongly agree, 43.5% agree) | Strong |
Treatment and management | ||
In patients with dysplastic BE or early esophageal adenocarcinoma, a diagnostic endoscopic resection should be performed on any raised or suspicious areas | 95.6% (65.2% strongly agree, 30.5% agree) | Strong |
In patients with BE-associated neoplasia, the goal of endoscopic treatment should be the complete eradication of the BE segment in addition to any dysplastic lesions | 100% (65.2% strongly agree, 34.8% agree) | Strong |
Quality indicator | Threshold | Process or outcome measure |
---|---|---|
Pre-procedure | ||
For patients in whom a diagnosis of dysplasia has been made, the rate at which the reading is made by a GI pathologist or confirmed by a second pathologist before EET is initiated | 90% (75, 100) | Process |
If EET is performed, HD-WLE and expertise in mucosal ablation and EMR techniques should be available | N/A | Process |
The rate at which documentation of a discussion of the risks, benefits, and alternatives to EET is obtained from the patient before a course of treatment is initiated | 99% (85, 100) | Process |
Intra-procedure | ||
The rate at which the landmarks and length of Barrett’s esophagus are documented (e.g., Prague grading system) in patients with Barrett’s esophagus before EET | 90% (75, 100) | Process |
The rate at which the presence or absence of visible lesions is reported (e.g., Paris classification) in patients with Barrett’s esophagus referred for EET | 90% (60, 100) | Process |
The rate at which the Barrett’s esophagus segment is inspected using HD-WLE | 95% (0, 100) | Process |
The rate at which CE-IM is achieved by 18 months in patients with Barrett’s-related dysplasia and intramucosal cancer referred for EET | 70% (50, 80) | Outcome |
Post-procedure | ||
Among patients who achieve CE-IM, the rate at which a recommendation for endoscopic surveillance at a defined interval is documented | 90% (50, 100) | Process |
During endoscopic surveillance after EET, the rate at which biopsies of any visible mucosal abnormalities are performed | 95% (50, 100) | Process |
The rate at which an anti-reflux regimen is recommended after EET | 90% (50, 100) | Process |
The rate at which adverse events are tracked and documented in individuals after EET | 90% (50, 100) | Process |
BE, Barrett’s esophagus. Adapted with permission from Sharma et al. [
GI, gastrointestinal; EET, endoscopic eradication therapy; HD-WLE, high-definition white light endoscopy; EMR, endoscopic mucosal resection; N/A, not available; CE-IM, complete eradication of intestinal metaplasia. Reprinted with permission from Wani et al. [