INTRODUCTION: Variability in adherence rates to the Seattle protocol and to surveillance interval recommendations, established quality indicators (QIs) in Barrett's esophagus (BE), is unknown.
METHODS:We evaluated endoscopist and site-based adherence rates to these QIs from January 2018 to May 2021 using the GI Quality Improvement Consortium national registry with matched endoscopy and pathology data.
RESULTS:Across 153 practices with 572 endoscopists performing 20,155 endoscopies, adherence to the Seattle protocol varied by endoscopists (median 93.8%, IQR 18.9%) and by site (median 90.0%, IQR 20.1%).Adherence to appropriate surveillance intervals for nondysplastic BE also varied by endoscopist (median 82.4%, IQR 36.3%) and site (median 77.2%, IQR 29.8%). The overall dysplasia detection rate was 3.1% and varied among endoscopists and sites.
DISCUSSION:These US population-based results can serve as a benchmark for quality initiatives and intervention trials aimed at improving outcomes for patients with BE.
Purpose of review Endoscopic eradication therapy is an effective and durable treatment for Barrett's esophagus (BE) related neoplasia, but even after achieving successful eradication, these patients remain at risk for recurrence and require ongoing routine examinations. The optimal surveillance protocol including endoscopic technique, sampling strategy, and timing are still being refined. The aim of this review is to discuss current management principles for the post ablation patient and emerging technologies to guide clinical practice. Recent findings There is increasing evidence to support less frequent surveillance exams in the first year after complete eradication of intestinal metaplasia and a move towards targeted biopsies of visible lesions and sampling high-risk locations such as the gastroesophageal junction. Promising technologies on the horizon that could impact management include novel biomarkers, personalized surveillance intervals, and non-endoscopic approaches. Summary Ongoing high-quality examinations after endoscopic eradication therapy are key to limiting recurrent BE. Surveillance intervals should be based on the pretreatment grade
Table 1. Comparison of efficacy endpoint results between the different vonoprazan doses and placebo Endpoint Vonoprazan 10 mg n552 Vonoprazan 20 mg n552 Vonoprazan 40 mg n551 Placebo n552 Heartburn episodes with complete and sustained relief within 3 hours a n/N evaluable episodes b (%) 201/359 (56.0) 198/327 (60.6) 226/323 (70.0) 101/370 (27.3) P-value (vs placebo) , 0.0001 , 0.0001 , 0.0001 -Timing of complete and sustained relief a , n/N evaluable episodes b (%) Within 30 minutes 31/359 (8.6) 17/327 (5.2) 9/323 (2.8) 21/370 (5.7) P-value (vs placebo) 0.15 0.87 0.09 -Within 1 hour 101/359 (28.1) 63/327 (19.3) 74/323 (22.9) 44/370 (11.9) P-value (vs placebo) , 0.0001 0.0083 0.0002 -Within 1.5 hours 151/359 (42.1) 103/327 (31.5) 139/323 (43.0) 67/370 (18.1) P-value (vs placebo) , 0.0001 , 0.0001 , 0.0001 -Within 2 hours 182/359 (50.7) 151/327 (46.2) 187/323 (57.9) 81/370 (21.9) P-value (vs placebo) , 0.0001 , 0.0001 , 0.0001 - (a)Complete and sustained relief is defined as complete relief with no antacid taken within the indicated time frame after taking study drug and no further heartburn reported for 24 hours after taking study drug. (b)An evaluable heartburn episode is defined as any for which study drug was taken and for which the subject completed $1 entry in the heartburn episode diary.
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