A Survey of Expert Practice and Attitudes Regarding Advanced Imaging Modalities in Surveillance of Barrett’s Esophagus

Jorge D. Machicado, Samuel Han, Rena H. Yadlapati, Violette C. Simon, Bashar J. Qumseya, Shahnaz Sultan, Vladimir M. Kushnir, Sri Komanduri, Amit Rastogi, V. Raman Muthusamy, Rehan Haidry, Krish Ragunath, Rajvinder Singh, Hazem T. Hammad, Nicholas J. Shaheen, Sachin Wani

Research output: Contribution to journalArticle

Abstract

Background: Published guidelines do not address what the minimum incremental diagnostic yield (IDY) for detection of dysplasia/cancer is required over the standard Seattle protocol for an advanced imaging modality (AIM) to be implemented in routine surveillance of Barrett’s esophagus (BE) patients. We aimed to report expert practice patterns and attitudes, specifically addressing the minimum IDY in the use of AIMs in BE surveillance. Methods: An international group of BE experts completed an anonymous electronic survey of domains relevant to surveillance practice patterns and use of AIMs. The evaluated AIMs were conventional chromoendoscopy (CC), virtual chromoendoscopy (VC), volumetric laser endomicroscopy (VLE), confocal laser endomicroscopy (CLE), and wide-area transepithelial sampling (WATS 3D ). Responses were recorded using five-point balanced Likert items and analyzed as continuous variables. Results: The survey response rate was 84% (61/73)—41 US and 20 non-US. Experts were most comfortable with and routinely use VC and CC, and least comfortable with and rarely use VLE, CLE, and WATS 3D . Experts rated data from randomized controlled trials (1.4 ± 0.9) and guidelines (2.6 ± 1.2) as the two most influential factors for implementing AIMs in clinical practice. The minimum IDY of AIMs over standard biopsies to be considered of clinical benefit was lowest for VC (15%, IQR 10–29%) and highest for VLE (30%, IQR 20–50%). Compared to US experts, non-US experts reported higher use of CC for BE surveillance (p < 0.001). Conclusion: These results should inform benchmarks that need to be met for guidelines to recommend the routine use of AIMs in the surveillance of BE patients.

Original languageEnglish (US)
Pages (from-to)3262-3271
Number of pages10
JournalDigestive Diseases and Sciences
Volume63
Issue number12
DOIs
StatePublished - Dec 1 2018

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Barrett Esophagus
Lasers
Guidelines
Benchmarking
Randomized Controlled Trials
Surveys and Questionnaires
Biopsy
Neoplasms

Keywords

  • Advanced imaging modalities
  • Barrett’s esophagus
  • Practice patterns
  • Surveillance

Cite this

A Survey of Expert Practice and Attitudes Regarding Advanced Imaging Modalities in Surveillance of Barrett’s Esophagus. / Machicado, Jorge D.; Han, Samuel; Yadlapati, Rena H.; Simon, Violette C.; Qumseya, Bashar J.; Sultan, Shahnaz; Kushnir, Vladimir M.; Komanduri, Sri; Rastogi, Amit; Muthusamy, V. Raman; Haidry, Rehan; Ragunath, Krish; Singh, Rajvinder; Hammad, Hazem T.; Shaheen, Nicholas J.; Wani, Sachin.

In: Digestive Diseases and Sciences, Vol. 63, No. 12, 01.12.2018, p. 3262-3271.

Research output: Contribution to journalArticle

Machicado, JD, Han, S, Yadlapati, RH, Simon, VC, Qumseya, BJ, Sultan, S, Kushnir, VM, Komanduri, S, Rastogi, A, Muthusamy, VR, Haidry, R, Ragunath, K, Singh, R, Hammad, HT, Shaheen, NJ & Wani, S 2018, 'A Survey of Expert Practice and Attitudes Regarding Advanced Imaging Modalities in Surveillance of Barrett’s Esophagus', Digestive Diseases and Sciences, vol. 63, no. 12, pp. 3262-3271. https://doi.org/10.1007/s10620-018-5257-3
Machicado, Jorge D. ; Han, Samuel ; Yadlapati, Rena H. ; Simon, Violette C. ; Qumseya, Bashar J. ; Sultan, Shahnaz ; Kushnir, Vladimir M. ; Komanduri, Sri ; Rastogi, Amit ; Muthusamy, V. Raman ; Haidry, Rehan ; Ragunath, Krish ; Singh, Rajvinder ; Hammad, Hazem T. ; Shaheen, Nicholas J. ; Wani, Sachin. / A Survey of Expert Practice and Attitudes Regarding Advanced Imaging Modalities in Surveillance of Barrett’s Esophagus. In: Digestive Diseases and Sciences. 2018 ; Vol. 63, No. 12. pp. 3262-3271.
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abstract = "Background: Published guidelines do not address what the minimum incremental diagnostic yield (IDY) for detection of dysplasia/cancer is required over the standard Seattle protocol for an advanced imaging modality (AIM) to be implemented in routine surveillance of Barrett’s esophagus (BE) patients. We aimed to report expert practice patterns and attitudes, specifically addressing the minimum IDY in the use of AIMs in BE surveillance. Methods: An international group of BE experts completed an anonymous electronic survey of domains relevant to surveillance practice patterns and use of AIMs. The evaluated AIMs were conventional chromoendoscopy (CC), virtual chromoendoscopy (VC), volumetric laser endomicroscopy (VLE), confocal laser endomicroscopy (CLE), and wide-area transepithelial sampling (WATS 3D ). Responses were recorded using five-point balanced Likert items and analyzed as continuous variables. Results: The survey response rate was 84{\%} (61/73)—41 US and 20 non-US. Experts were most comfortable with and routinely use VC and CC, and least comfortable with and rarely use VLE, CLE, and WATS 3D . Experts rated data from randomized controlled trials (1.4 ± 0.9) and guidelines (2.6 ± 1.2) as the two most influential factors for implementing AIMs in clinical practice. The minimum IDY of AIMs over standard biopsies to be considered of clinical benefit was lowest for VC (15{\%}, IQR 10–29{\%}) and highest for VLE (30{\%}, IQR 20–50{\%}). Compared to US experts, non-US experts reported higher use of CC for BE surveillance (p < 0.001). Conclusion: These results should inform benchmarks that need to be met for guidelines to recommend the routine use of AIMs in the surveillance of BE patients.",
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AU - Han, Samuel

AU - Yadlapati, Rena H.

AU - Simon, Violette C.

AU - Qumseya, Bashar J.

AU - Sultan, Shahnaz

AU - Kushnir, Vladimir M.

AU - Komanduri, Sri

AU - Rastogi, Amit

AU - Muthusamy, V. Raman

AU - Haidry, Rehan

AU - Ragunath, Krish

AU - Singh, Rajvinder

AU - Hammad, Hazem T.

AU - Shaheen, Nicholas J.

AU - Wani, Sachin

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N2 - Background: Published guidelines do not address what the minimum incremental diagnostic yield (IDY) for detection of dysplasia/cancer is required over the standard Seattle protocol for an advanced imaging modality (AIM) to be implemented in routine surveillance of Barrett’s esophagus (BE) patients. We aimed to report expert practice patterns and attitudes, specifically addressing the minimum IDY in the use of AIMs in BE surveillance. Methods: An international group of BE experts completed an anonymous electronic survey of domains relevant to surveillance practice patterns and use of AIMs. The evaluated AIMs were conventional chromoendoscopy (CC), virtual chromoendoscopy (VC), volumetric laser endomicroscopy (VLE), confocal laser endomicroscopy (CLE), and wide-area transepithelial sampling (WATS 3D ). Responses were recorded using five-point balanced Likert items and analyzed as continuous variables. Results: The survey response rate was 84% (61/73)—41 US and 20 non-US. Experts were most comfortable with and routinely use VC and CC, and least comfortable with and rarely use VLE, CLE, and WATS 3D . Experts rated data from randomized controlled trials (1.4 ± 0.9) and guidelines (2.6 ± 1.2) as the two most influential factors for implementing AIMs in clinical practice. The minimum IDY of AIMs over standard biopsies to be considered of clinical benefit was lowest for VC (15%, IQR 10–29%) and highest for VLE (30%, IQR 20–50%). Compared to US experts, non-US experts reported higher use of CC for BE surveillance (p < 0.001). Conclusion: These results should inform benchmarks that need to be met for guidelines to recommend the routine use of AIMs in the surveillance of BE patients.

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