Zagari Rocco Maurizio, Eusebi Leonardo Henry, Galloro Giuseppe, Rabitti Stefano, Neri Matteo, Pasquale Luigi, Bazzoli Franco
Department of Medical and Surgical Sciences, University of Bologna, Policlinico S. Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy.
Surgical Digestive Endoscopy, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
Dig Dis Sci. 2021 Sep;66(9):2888-2896. doi: 10.1007/s10620-020-06615-6. Epub 2020 Sep 28.
BACKGROUND: Little is known on practice patterns of endoscopists for the management of Barrett's esophagus (BE) over the last decade. AIMS: Our aim was to assess practice patterns of endoscopists for the diagnosis, surveillance and treatment of BE. METHODS: All members of the Italian Society of Digestive Endoscopy (SIED) were invited to participate to a questionnaire-based survey. The questionnaire included questions on demographic and professional characteristics, and on diagnosis and management strategies for BE. RESULTS: Of the 883 SIED members, 259 (31.1%) completed the questionnaire. Of these, 73% were males, 42.9% had > 50 years of age and 68.7% practiced in community hospitals. The majority (82.9%) of participants stated to use the Prague classification; however 34.5% did not use the top of gastric folds to identify the gastro-esophageal junction (GEJ); only 51.4% used advanced endoscopy imaging routinely. Almost all respondents practiced endoscopic surveillance for non-dysplastic BE, but 43.7% performed eradication in selected cases and 30% practiced surveillance every 1-2 years. The majority of endoscopists managed low-grade dysplasia with surveillance (79.1%) and high-grade dysplasia with ablation (77.1%). Attending a training course on BE in the previous 5 years was significantly associated with the use of the Prague classification (OR 4.8, 95% CI 1.9-12.1), the top of gastric folds as landmark for the GEJ (OR 2.45, 95% CI 1.27-4.74) and advanced imaging endoscopic techniques (OR 3.33, 95% CI 1.53-7.29). CONCLUSIONS: Practice patterns for management of BE among endoscopists are variable. Attending training courses on BE improves adherence to guidelines.
背景:在过去十年中,关于内镜医师对巴雷特食管(BE)的管理实践模式知之甚少。 目的:我们的目的是评估内镜医师对BE的诊断、监测和治疗的实践模式。 方法:邀请意大利消化内镜学会(SIED)的所有成员参与一项基于问卷的调查。问卷包括有关人口统计学和专业特征以及BE的诊断和管理策略的问题。 结果:在883名SIED成员中,259名(31.1%)完成了问卷。其中,73%为男性,42.9%年龄超过50岁,68.7%在社区医院执业。大多数(82.9%)参与者表示使用布拉格分类法;然而,34.5%未使用胃皱襞顶部来识别胃食管交界处(GEJ);只有51.4%常规使用先进的内镜成像技术。几乎所有受访者都对非发育异常的BE进行内镜监测,但43.7%在某些情况下进行根除,30%每1 - 2年进行一次监测。大多数内镜医师对低级别发育异常进行监测(79.1%),对高级别发育异常进行消融治疗(77.1%)。在过去5年中参加过BE培训课程与使用布拉格分类法(OR 4.8,95%CI 1.9 - 12.1)、以胃皱襞顶部作为GEJ的标志(OR 2.45,95%CI 1.27 - 4.74)以及先进的内镜成像技术(OR 3.33,95%CI 1.53 - 7.29)显著相关。 结论:内镜医师对BE的管理实践模式各不相同。参加BE培训课程可提高对指南的依从性。
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