Das Debasish, Ishaq Savid, Harrison Rebecca, Kosuri Kiran, Harper Edward, Decaestecker John, Sampliner Richard, Attwood Stephen, Barr Hugh, Watson Peter, Moayyedi Paul, Jankowski Janusz
Digestive Disease Centre, Leicester Royal Infirmary, Leicester, UK.
Am J Gastroenterol. 2008 May;103(5):1079-89. doi: 10.1111/j.1572-0241.2008.01790.x. Epub 2008 Apr 28.
To assess the variation in practice of Barrett's esophagus (BE) management in comparison with accepted international guidelines before and after the introduction of a large BE randomized controlled trial (RCT) with protocols including those of tissue sampling.
A validated anonymized questionnaire was sent to 401 senior attending gastroenterologists asking for details of their current management of BE, especially histological sampling. Of the 228 respondents, 57 individuals (each from a different center) were in the first group to enter the ASPirin Esomeprazole (BE) Chemoprevention Trial (AspECT), and we assessed change in practice in these centers.
Ninety percent of specialists did not take adequate biopsies for histological diagnosis. Furthermore, 74% would consider aggressive surgical resection for prevalent cases of high-grade dysplasia in BE as their first-line choice despite the associated perioperative mortality. Ninety-two percent claim their lack of adherence to guidelines is because there is a need for stronger evidence for surveillance and medical interventions. Effect of the AspECT trial: Those clinicians in centers where the AspECT trial has started have improved adherence to ACG guidelines compared with their previous practice (P < 0.05). BE patients now get 18.8% more biopsies compared with previous practice, and 37.7% if the patient is entered into the AspECT trial (P < 0.01).
This large study indicates both wide variation in practice and poor compliance with guidelines. Because optimal histology is arguably the most important facet of BE management, the improvement in practice in centers taking part in the AspECT trial indicates an additional value of large international RCTs.
在一项大型巴雷特食管（BE）随机对照试验（RCT）及其包括组织采样方案在内的方案引入前后，评估BE管理实践与公认的国际指南相比的差异。
向401名高级胃肠病学主治医生发送了一份经过验证的匿名问卷，询问他们当前对BE的管理细节，尤其是组织学采样。在228名受访者中，57人（每人来自不同中心）是首批进入阿司匹林埃索美拉唑（BE）化学预防试验（AspECT）的，我们评估了这些中心的实践变化。
90%的专家未进行足够的活检用于组织学诊断。此外，74%的人会将BE中高级别异型增生的常见病例的积极手术切除视为一线选择，尽管存在相关围手术期死亡率。92%的人声称他们不遵守指南是因为需要更强有力的证据来进行监测和医学干预。AspECT试验的影响：与之前的实践相比，AspECT试验已启动的中心的临床医生对美国胃肠病学会（ACG）指南的依从性有所提高（P<0.05）。与之前的实践相比，BE患者现在的活检次数增加了18.8%，如果患者参加AspECT试验则增加了37.7%（P<0.01）。
这项大型研究表明实践存在广泛差异且对指南的依从性较差。由于最佳组织学可说是BE管理最重要的方面，参与AspECT试验的中心实践的改善表明大型国际RCT还有额外价值。
