TOPLINE:

Expert gastroenterologists in the US show notable variability in managing Barrett esophagus (BE), with 47% never offering ablation for nondysplastic cases and 44% saying they remained neutral or disagreed with diagnoses from community gastroenterologists’ biopsies.

METHODOLOGY:

• Despite updated guidelines, significant variability persists in BE management, leading to inconsistent practices, particularly regarding surveillance intervals and recommendations for endoscopic eradication therapy.
• Researchers conducted an online survey between March and April 2022 of expert gastroenterologists in the US specializing in BE management. Eligible participants had at least 10 publications focused on BE, maintained a dedicated BE care practice, and/or were selected through consensus recommendations among the study authors.
• The 38-item questionnaire covered demographics, medical and endoscopic management opinion, and endoscopic eradication therapy strategies.
• Participants ranked their agreement on a 5-point Likert scale to assess trends in screening, surveillance, and therapy.
• The primary outcome was to identify variations in practice management among BE experts.

TAKEAWAY:

• Of 38 experts invited, 34 responded (89% response rate); the majority were male (85%) and practiced in an academic tertiary hospital (82%).
• Half reported discussing the risk for BE during initial consultations for gastroesophageal reflux disease (GERD), with 61.8% agreeing and 11.8% strongly agreeing that BE should be considered in women with chronic GERD.
• Although 35.3% supported using wide-area transepithelial sampling with three-dimensional computer-assisted analysis for diagnosing BE, over 55% did not use it alongside standard biopsies. Additionally, 44% remained neutral or disagreed with BE diagnoses from community gastroenterologists’ biopsies.
• Radiofrequency ablation was the most common first-line therapy, yet 47% of experts never offered it for nondysplastic BE. For low-grade dysplasia, nearly all experts offered ablation, with 44% stating they always offered it and 41% that they often did.
• Reflux monitoring was performed by 67% of experts for all patients refractory to ablation. For patients who underwent anti-reflux surgery, 47% of experts reported restarting daily proton pump inhibitor therapy indefinitely post-surgery.

IN PRACTICE:

“The survey results emphasize the necessity for ongoing dialog and education among BE specialists to bridge the gaps between evidence-based guidelines and clinical practice,” the authors of the study wrote.

SOURCE:

The study was led by Fangfang Wang, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix. It was published online in the Journal of Clinical Gastroenterology.

LIMITATIONS:

The cross-sectional design limited the ability to assess the rationale behind expert responses. As only US experts were included, findings may not be generalizable to other regions. The majority of participants were from academic institutions, which may not reflect community practice.

DISCLOSURES:

No funding was reported for the study. Three authors served as consultants for various sources, including diagnostic and medical device companies. One reported receiving research funding, while another reported being a member of a data safety monitoring board.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.