Abstract
BACKGROUND AND AIMS: Barrett's esophagus endoscopic surveillance is prone to poor guideline adherence. This study was undertaken to obtain pilot data comparing standard care with a dedicated Barrett's endoscopy service. METHODS: Adults with nondysplastic Barrett's esophagus at 2 sites in the northwest of England were randomized to a dedicated service versus a nondedicated service for their routine surveillance. On the dedicated arm, 64% were male; 72% in the nondedicated arm were male. Median ages were 66 years and 63 years in the dedicated and nondedicated arms, and mean Prague circumferential length was 2 cm and 3 cm, respectively. The dedicated service was performed by endoscopists trained in Barrett's assessment on specific sessions. Data were obtained on dysplasia detection and adherence to British Society of Gastroenterology guidelines. RESULTS: Of 111 recruited cases (80% recruitment rate), 92 underwent endoscopy (39 were correctly performed on the dedicated arm and 25 on the nondedicated arm). In the dedicated arm, 5 (13%) cases of dysplasia were found; 2 (8%) cases of dysplasia were found in the nondedicated arm. Guideline adherence was better in the dedicated arm, particularly Prague classification documentation (37 of 39 [95%] vs 20 of 25 [80%]) and Seattle protocol adherence (34 of 39 [87%] vs 15 of 25 [60%]). Post hoc analysis with χ(2) test showed improved Seattle protocol adherence (34 of 37 dedicated vs 15 of 24 nondedicated, P = .005), visible lesion documentation (37 of 38 dedicated vs 12 of 23 nondedicated, P ≤ .001), and use of targeted biopsies (25 of 39 dedicated vs 3 of 25, nondedicated P ≤ .001). CONCLUSIONS: This study is the first pilot randomized trial of dedicated services versus non-dedicated services for Barrett's surveillance. It shows that the study design is feasible and informs a future powered multicenter study. (Clinical trial registration number: ISRCTN12259569.).