Post-endoscopy Barrett's neoplasia after a negative index endoscopy: A systematic review and proposal for definitions and performance measures in endoscopy

Madhav Desai, David Lieberman, Sachin Srinivasan, Venkat Nutalapati, Abhishek Challa, Pankush Kalgotra, Suneha Sundaram, Alessandro Repici, Cesare Hassan, Michal F. Kaminski, Prateek Sharma

Research output: Contribution to journalReview articlepeer-review

Abstract

Background A high rate of neoplasia, both high grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) has been reported in Barrett's esophagus at index endoscopy, but precise rates of post-endoscopy Barrett's neoplasia (PEBN) are unknown. Methods A systematic review and meta-analysis was performed examining electronic databases (inception to October 2021) for studies reporting PEBN. Consistent with the definitions of post-colonoscopy colorectal cancer proposed by the World Endoscopy Organization, we defined neoplasia (HGD/EAC) detected at index endoscopy and/or within 6 months of a negative index endoscopy as "prevalent" neoplasia, that detected after 6 months of a negative index endoscopy and prior to next surveillance interval (i. e. 3 years) as PEBN or "interval" neoplasia, and that detected after 36 months from a negative index endoscopy as "incident" neoplasia. The pooled incidence rates and proportions relative to total neoplasia were analyzed. Results 11 studies (n = 59 795; 61% men; mean [SD] age 62.3 [3.3] years) met the inclusion criteria. The pooled incidence rates were: prevalent neoplasia 4.5% (95 %CI 2.2%- 8.9%) at baseline and an additional 0.3% (0.1%-0.7%) within the first 6 months, PEBN 0.52% (0.46%-0.58 %), and incident neoplasia 1.4% (0.9%-2.1%). At 3 years from the index endoscopy, PEBN accounted for 3% of total Barrett's neoplasia, while prevalent neoplasia accounted for 97%. Conclusion Neoplasia detected at or within 6 months of index endoscopy accounts for most cases of Barrett's neoplasia (> 90 %). PEBN accounts for ~3% of cases and can be used for validation in future. This highlights the importance of a high quality index endoscopy in Barrett's esophagus and the need to establish quality benchmarks to measure endoscopists' performance.

Original languageEnglish (US)
JournalEndoscopy
DOIs
StateAccepted/In press - 2022
Externally publishedYes

ASJC Scopus subject areas

  • Gastroenterology

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