Management of Barrett's high-grade dysplasia

initial results from a population-based national audit

Georgina Chadwick*, Oliver Groene, Angelina Taylor, Stuart Riley, Richard H. Hardwick, Tom Crosby, Kimberley Greenaway, David A. Cromwell

*Corresponding author for this work

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background and Aims: Previous studies reported significant variation in the management of patients with Barrett's esophagus. However, these are based on self-reported clinical practice. The aim of this study was to examine the management of high-grade dysplasia in Barrett's esophagus in England by using patient-level data and to compare practice with guidelines. 

Methods: From April 2012 to March 2013, National Health Service (NHS) trusts in England prospectively collected data on patients newly diagnosed with high-grade dysplasia (HGD) of the esophagus as part of the National Oesophago-Gastric Cancer Audit. Data were collected on patient characteristics, diagnosis and endoscopic findings, treatment planning, and therapy. 

Results: Between April 2012 and March 2013, NHS trusts reported 465 cases of HGD. Diagnosis was confirmed by a second pathologist in 79.4% of cases (270/340), and 86.0% (374/465) had their treatment planned at a multidisciplinary team meeting. A total of 290 patients (62.4%) were managed endoscopically (frequently with endoscopic resection or radiofrequency ablation), whereas 26 patients (5.6%) had esophagectomy. The proportion of patients managed by surveillance varied by age (P <.001), ranging from 19.5% in patients aged <65 years to 63.8% in patients aged ≥85 years. More patients received active treatment if their cases were discussed at a multidisciplinary meeting (73.5% vs 44.3%; P <.001) or managed at higher-volume trusts (87.8% vs 55.4%; P <.001). 

Conclusions: There was marked variation in the management of HGD across England, with a third of patients receiving no active treatment. Patients discussed at a specialist multidisciplinary meeting or managed in high-volume trusts were more likely to receive active treatment.

Original languageEnglish
Pages (from-to)736-742.e1
Number of pages8
JournalGastrointestinal Endoscopy
Volume83
Issue number4
DOIs
Publication statusPublished - Apr 2016
Externally publishedYes

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    Chadwick, G., Groene, O., Taylor, A., Riley, S., Hardwick, R. H., Crosby, T., ... Cromwell, D. A. (2016). Management of Barrett's high-grade dysplasia: initial results from a population-based national audit. Gastrointestinal Endoscopy, 83(4), 736-742.e1. https://doi.org/10.1016/j.gie.2015.08.020