Lin Otto S, Mannava S, Hwang K-L, Triadafilopoulos G
Division of Gastroenterology, Stanford University Medical Center, California, USA.
Dis Esophagus. 2002;15(1):39-45. doi: 10.1046/j.1442-2050.2002.00221.x.
We evaluated the reasons for current practices in managing Barrett's esophagus. Using a questionnaire, we assessed the practices and beliefs of 162 Californian gastroenterologists in managing Barrett's esophagus, using descriptive statistics as well as multivariate logistic regression. Out of the 103 respondents, 87% screened for Barrett's esophagus in patients with > 12 months of reflux symptoms, but only 72% believed that screening would improve survival, and 48% believed it to be cost-effective. In total, 98% surveyed patients with long-segment Barrett's esophagus at least biennially (76% thought this would improve survival and 49% believed it to be cost-effective) and 82% surveyed short-segment Barrett's esophagus at least biennially (57% thought this would improve survival and 30% believed it to be cost-effective). Finally, 44% surveyed microscopic intestinal metaplasia at least biennially (26% thought this would improve survival and 11% believed it to be cost-effective). In total, 18% performed endoscopic ablation, whereas 3% referred patients with low-grade dysplasia and 85% referred patients with high-grade dysplasia for esophagectomy. Finally, 81% treated asymptomatic Barrett's esophagus patients with proton pump inhibitors, but only 56% believed that this would reduce the risk of cancer. Logistic regression showed that the only independent factor predictive of surveillance practices was belief in efficacy. Practice patterns tend to be more aggressive than those recommended by recent guidelines and those reported by previous surveys. Medico-legal considerations affect practice substantially.
我们评估了当前巴雷特食管管理实践的原因。通过问卷调查，我们使用描述性统计以及多变量逻辑回归，评估了162名加利福尼亚胃肠病学家在巴雷特食管管理方面的实践和信念。在103名受访者中，87%对有超过12个月反流症状的患者进行巴雷特食管筛查，但只有72%的人认为筛查能提高生存率，48%的人认为筛查具有成本效益。总体而言，98%的受访者至少每两年对长段巴雷特食管患者进行一次检查（76%的人认为这能提高生存率，49%的人认为具有成本效益），82%的受访者至少每两年对短段巴雷特食管患者进行一次检查（57%的人认为这能提高生存率，30%的人认为具有成本效益）。最后，44%的受访者至少每两年对微观肠化生进行一次检查（26%的人认为这能提高生存率，11%的人认为具有成本效益）。总体而言，18%的人进行内镜下消融，而3%的人将低级别异型增生患者转诊，85%的人将高级别异型增生患者转诊进行食管切除术。最后，81%的人用质子泵抑制剂治疗无症状的巴雷特食管患者，但只有56%的人认为这能降低癌症风险。逻辑回归显示，预测监测实践的唯一独立因素是对疗效的信念。实践模式往往比近期指南推荐的以及先前调查报道的更为激进。医疗法律因素对实践有重大影响。
