Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, USA.
Dig Dis Sci. 2023 Sep;68(9):3584-3595. doi: 10.1007/s10620-023-07968-4. Epub 2023 Jul 5.
Endoscopic eradication therapy for Barrett's esophagus (BE)-related neoplasia is increasingly being performed at tertiary and community centers. While it has been suggested that these patients should be evaluated at expert centers, the impact of this practice has not been evaluated. We aimed to assess the impact of referral of BE-related neoplasia patients to expert centers by assessing the proportion of patients with change in pathological diagnosis and visible lesions detected.
Multiple databases were searched until December 2021 for studies of patients with BE referred from the community to expert center. The proportions of pathology grade change and newly detected visible lesions at expert centers were pooled using a random-effects model. Subgroup analyses were performed based on baseline histology and other relevant factors.
Twelve studies were included (1630 patients). The pooled proportion of pathology grade change after expert pathologist review was 47% (95% CI 34-59%) overall and 46% (95% CI 31-62%) among patients with baseline low-grade dysplasia. When upper endoscopy was repeated at an expert center, the pooled proportion of pathology grade change was still high 47% (95% 26-69%) overall and 40% (95% CI 34-45%) among patients with baseline LGD. The pooled proportion of newly detected visible lesions was 45% (95% CI 28-63%) and among patients referred with LGD was 27% (95% CI 22-32%).
An alarmingly high proportion of newly detected visible lesions and pathology grade change were found when patients were referred to expert centers supporting the need for centralized care for BE-related neoplasia patients.
Barrett 食管（BE）相关肿瘤的内镜下根除治疗越来越多地在三级和社区中心进行。虽然有人建议这些患者应在专家中心进行评估，但这种做法的影响尚未得到评估。我们旨在通过评估病理诊断改变和可见病变检出率的变化来评估将 BE 相关肿瘤患者转诊至专家中心的影响。
直到 2021 年 12 月，我们在多个数据库中搜索了将 BE 患者从社区转诊至专家中心的研究。使用随机效应模型汇总专家中心的病理分级改变和新发现的可见病变的比例。根据基线组织学和其他相关因素进行亚组分析。
共纳入 12 项研究（1630 例患者）。专家病理医生审查后病理分级改变的总体比例为 47%（95%CI 34-59%），基线低级别异型增生患者为 46%（95%CI 31-62%）。在专家中心重复进行上消化道内镜检查时，整体病理分级改变的比例仍然很高，为 47%（95%CI 26-69%），基线低级别异型增生患者为 40%（95%CI 34-45%）。新发现的可见病变的总体比例为 45%（95%CI 28-63%），基线低级别异型增生患者为 27%（95%CI 22-32%）。
当患者被转诊至专家中心时，发现了大量新的可见病变和病理分级改变，这支持了对 BE 相关肿瘤患者进行集中治疗的必要性。
