Gastroenterology and Hepatology, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri, USA; Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Missouri, USA.
Gastrointest Endosc. 2013 Nov;78(5):689-95. doi: 10.1016/j.gie.2013.05.002. Epub 2013 Jun 14.
Endoscopic management of Barrett's esophagus (BE) has evolved over the past decade; however, the practice patterns for managing BE among gastroenterologists remain unclear.
To assess practice patterns for management of BE among gastroenterologists working in various practice settings.
A random questionnaire-based survey of practicing gastroenterologists in the United States. The questionnaire contained a total of 10 questions pertaining to practice setting, physician demographics, and strategies used for managing BE.
Survey of gastroenterologists working in various practice settings.
Questionnaire.
Practice patterns for endoscopic imaging and management of BE.
The response rate was 45% (236/530). The majority (85%) were gastroenterologists in community practice, 72% were aged 41 to 60 years, 80% had >10 years of experience, and 81% had attended postgraduate courses and/or seminars on BE management. A total of 78% did not use the Prague C & M classification, and about a third used advanced endoscopic imaging routinely (37%) or in selected cases (31%). For nondysplastic BE, 86% practiced surveillance, 12% performed ablation, and 3% did no intervention. For BE with low-grade dysplasia, 56% practiced surveillance, 26% performed endoscopic ablation in all low-grade dysplasia cases, and 18% performed endoscopic ablation in only selected patients with low-grade dysplasia. The majority of respondents (58%) referred their patients with high-grade dysplasia to centers with BE expertise, 13% performed endoscopic ablation in all patients with high-grade dysplasia, 25% performed endoscopic ablation in selected cases only, and 3% referred these patients for surgery. The most frequently used endoscopic eradication therapy was radiofrequency ablation (39%) followed by EMR (17%).
The sample may be unrepresentative, participation in the study was voluntary, and responses may be skewed toward following the guidelines.
Results from this survey show that the majority of practicing gastroenterologists in the United States practice surveillance endoscopy in patients with nondysplastic BE and provide endoscopic therapy for those with high-grade dysplasia. The Prague C & M classification and advanced imaging techniques are used by less than a third of gastroenterologists. Practice patterns did not appear to be affected by respondent age or duration of clinical practice.
过去十年中，内镜下 Barrett 食管（BE）的管理已经发展；然而，胃肠病学家管理 BE 的实践模式仍不清楚。
评估在不同实践环境中工作的胃肠病学家管理 BE 的实践模式。
对美国从事各种实践的胃肠病学家进行随机基于问卷的调查。问卷共包含 10 个问题，涉及实践环境、医生人口统计学以及用于管理 BE 的策略。
在各种实践环境中调查胃肠病学家。
问卷调查。
内镜成像和 BE 管理的实践模式。
应答率为 45%（236/530）。大多数（85%）是社区实践的胃肠病学家，72%的年龄在 41 至 60 岁之间，80%的经验超过 10 年，81%参加过 BE 管理的研究生课程和/或研讨会。共有 78%的人不使用布拉格 C&M 分类，大约三分之一的人常规使用高级内镜成像（37%）或在选定病例中使用（31%）。对于非异型增生性 BE，86%进行监测，12%对所有低级别异型增生病例进行消融，3%不进行干预。对于低级别异型增生性 BE，56%进行监测，26%对所有低级别异型增生病例进行内镜消融，18%仅对低级别异型增生的选定患者进行内镜消融。大多数受访者（58%）将高级别异型增生患者转介至 BE 专业中心，13%对所有高级别异型增生患者进行内镜消融，25%仅对选定病例进行内镜消融，3%将这些患者转介给外科医生。最常使用的内镜根除治疗是射频消融（39%），其次是 EMR（17%）。
样本可能没有代表性，参与研究是自愿的，并且答复可能偏向于遵循指南。
这项调查结果表明，美国大多数从事实践的胃肠病学家在非异型增生性 BE 患者中进行监测性内镜检查，并为高级别异型增生患者提供内镜治疗。不到三分之一的胃肠病学家使用布拉格 C&M 分类和高级成像技术。实践模式似乎不受受访者年龄或临床实践时间的影响。
