Original article Reasons for current practices in managing Barrett’s esophagus Otto S. Lin, 1,2,3 S. Mannava, 1 K.-L. Hwang, 3 G. Triadafilopoulos 1 1 Division of Gastroenterology, Stanford University Medical Center, 2 Centre for Primary Care and Outcomes Research, Stanford University School of Medicine, California, USA, and 3 Department of Health Services Research, ChangHua Christian Medical Center, ChangHua, Taiwan SUMMARY. We evaluated the reasons for current practices in managing Barrett’s esophagus. Using a questionnaire, we assessed the practices and beliefs of 162 Californian gastroenterologists in managing Barrett’s esophagus, using descriptive statistics as well as multivariate logistic regression. Out of the 103 respondents, 87% screened for Barrett’s esophagus in patients with > 12 months of reflux symptoms, but only 72% believed that screening would improve survival, and 48% believed it to be cost-effective. In total, 98% surveyed patients with long-segment Barrett’s esophagus at least biennially (76% thought this would improve survival and 49% believed it to be cost-effective) and 82% surveyed short-segment Barrett’s esophagus at least biennially (57% thought this would improve survival and 30% believed it to be cost-effective). Finally, 44% surveyed microscopic intestinal metaplasia at least biennially (26% thought this would improve survival and 11% believed it to be cost-effective). In total, 18% performed endoscopic ablation, whereas 3% referred patients with low-grade dysplasia and 85% referred patients with high-grade dysplasia for esophagectomy. Finally, 81% treated asymptomatic Barrett’s esophagus patients with proton pump inhibitors, but only 56% believed that this would reduce the risk of cancer. Logistic regression showed that the only independent factor predictive of surveillance practices was belief in efficacy. Practice patterns tend to be more aggressive than those recommended by recent guidelines and those reported by previous surveys. Medico-legal considerations affect practice substantially. INTRODUCTION It is estimated that Barrett’s esophagus (BE) affects nearly700000peopleintheUSA,andcarriesarisk of esophageal adenocarcinoma that is 30–125 times that of an age-matched population. 1 The rising incidence of esophageal adenocarcinoma in recent years 2 haspromptedunprecedentedresearchinterest. Currently, much is still unknown about the natural history of BE, and there is ongoing controversy regarding many aspects of management. Previous surveys in the USA and UK have found that most gastroenterologists perform endoscopic surveillance for BE, and that many will recommend esophagec- tomyifhigh-gradedysplasiaisdetected. 3–6 However, little is known about current practice patterns with regard to endoscopic screening for BE in chronic gastroesophageal reflux disease (GERD) patients, ablative treatment of BE and dysplasia, eradication of Helicobacter pylori in BE patients, and acid suppressive or surgical treatment of BE. It is also unclear whether recently published guidelines by the American College of Gastroenterology (ACG) 7 with comprehensive recommendations for the screening, surveillance and treatment of BE and GERD, have influenced practice patterns. Our goal was to deter- mine the practice patterns of practicing gastroenter- ologists, and to gain some insight about the popularity of new management approaches for this condition. MATERIALS AND METHODS Subject selection During three regional gastroenterology conferences in late 1999, a random sample (determined by the conference registration number) of 162 actively practicing gastroenterologists, based in California, were asked to fill out a questionnaire. To be eligible, studyparticipantshadtobeinactiveclinicalpractice (defined as caring for at least 25 patients with gastrointestinal problems per week), had to have Address correspondence to: Dr O. S. Lin, C3-GAS, Gastroenter- ology Section, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98101, USA. Tel: (+1) 206 223 7558; Fax: (+1) 206 223 6379; E-mail: otto.lin@vmmc.org 39 Diseases of the Esophagus (2002) 15, 39–45 Ó 2002 ISDE/Blackwell Publishing Asia Downloaded from https://academic.oup.com/dote/article/15/1/39/2420017 by guest on 22 July 2022