Dedicated endoscopy for Barrett's esophagus randomized blinded pilot study: comparing a dedicated Barrett's surveillance service with standard care.

BACKGROUND AND AIMS: Barrett's esophagus endoscopic surveillance is prone to poor guideline adherence. This study was undertaken to obtain pilot data comparing standard care with a dedicated Barrett's endoscopy service.

METHODS

Adults with nondysplastic Barrett's esophagus at 2 sites in the northwest of England were randomized to a dedicated service versus a nondedicated service for their routine surveillance. On the dedicated arm, 64% were male; 72% in the nondedicated arm were male. Median ages were 66 years and 63 years in the dedicated and nondedicated arms, and mean Prague circumferential length was 2 cm and 3 cm, respectively. The dedicated service was performed by endoscopists trained in Barrett's assessment on specific sessions. Data were obtained on dysplasia detection and adherence to British Society of Gastroenterology guidelines.

RESULTS

Of 111 recruited cases (80% recruitment rate), 92 underwent endoscopy (39 were correctly performed on the dedicated arm and 25 on the nondedicated arm). In the dedicated arm, 5 (13%) cases of dysplasia were found; 2 (8%) cases of dysplasia were found in the nondedicated arm. Guideline adherence was better in the dedicated arm, particularly Prague classification documentation (37 of 39 [95%] vs 20 of 25 [80%]) and Seattle protocol adherence (34 of 39 [87%] vs 15 of 25 [60%]). Post hoc analysis with χ2 test showed improved Seattle protocol adherence (34 of 37 dedicated vs 15 of 24 nondedicated, P = .005), visible lesion documentation (37 of 38 dedicated vs 12 of 23 nondedicated, P ≤ .001), and use of targeted biopsies (25 of 39 dedicated vs 3 of 25, nondedicated P ≤ .001).

CONCLUSIONS

This study is the first pilot randomized trial of dedicated services versus non-dedicated services for Barrett's surveillance. It shows that the study design is feasible and informs a future powered multicenter study. (Clinical trial registration number: ISRCTN12259569.).