The development of and adherence to quality indicators in gastroenterology as

The development of and adherence to quality indicators in gastroenterology as in all of medicine is increasing in importance to ensure that patients receive consistent high-quality care. candidate quality indicators achieved >80% agreement. These statements are intended to serve as a consensus on candidate quality indicators for those who treat patients with Barrett’s esophagus. infection and older age while BE is associated with gastroesophageal CCT244747 reflux disease. The malignant potential of intestinal metaplasia of cardia is not entirely clear but studies to date indicate that it has an extremely low risk of progression to cancer.20-24 Sharma et al20 prospectively evaluated the risk of dysplasia in 177 patients with short segment Barrett’s esophagus (SSBE) and cardia intestinal metaplasia (n = CCT244747 76). Dysplasia prevalence was significantly higher in patients with SSBE compared with those with cardia intestinal metaplasia (11.3% vs 1.3%; = .0058). When patients with SSBE (n = 78) and cardia intestinal metaplasia (n = 34) were followed for a mean of 31 months (range 8 – 100 CCT244747 months) and 24 months (range 6 – 80 months) respectively 9 patients with SSBE developed dysplasia (7 LGD and 2 HGD) while only 1 1 patient with cardia intestinal metaplasia developed dysplasia. The time to dysplasia development was significantly longer in CCT244747 patients with cardia intestinal metaplasia (= .0077 per log-rank test). While 1 patient with HGD in a patient with SSBE progressed to adenocarcinoma LGD was not detected on repeat endoscopy in the patient with cardia intestinal metaplasia 1 year later.20 Similarly in a population-based cohort study in 2011 by Jung et al 24 487 patients (401 with BE and 86 with intestinal metaplasia from normal or “irregularly”-appearing squamo-columnar junction) were identified in Minnesota and followed for a median interval of 7 years (BE) or 8 years (intestinal metaplasia at the GEJ). Of 355 patients in BE group with no prevalent HGD/EAC in 12 months 18 progressed to dysplasia (10 from no dysplasia to HGD 6 from no dysplasia to HGD and Cspg2 2 from LGD to HGD). Of 55 (64%) patients with intestinal metaplasia at the GEJ who underwent at least 1 subsequent endoscopy LGD that was detected in 6 patients on first endoscopy was not found on subsequent endoscopies and none of these patients progressed to EAC.24 Based on these findings the experts agreed that this quality indicator will reduce the incorrect labeling of a patient with BE and subsequently reduce any future surveillance if contemplated. Surveillance Statement 4: If systematic surveillance biopsies performed in a patient known to have BE show no evidence of dysplasia follow-up surveillance endoscopy should be recommended no sooner than 3 to 5 5 years. = = .159). However patients in the APC group had a significantly lower number of secondary lesions (n = 1 [3%]) compared with those in the surveillance group (n = 11 [36.7%]) and therefore significantly higher recurrence-free survival in patients who underwent APC ablation of the residual BE (= .005).43 Similarly other studies showed a high rate of metachronous lesions in the BE segment in patients treated with endoscopic eradication therapies if residual BE persists.44 Based on the evidence from these studies experts agreed that if the entire BE segment is not treated the rate of cancer recurrence is high. Overall Discussion: Candidate Quality Measures CCT244747 in Barrett’s Esophagus and International Consensus Diagnosis and treatment of BE remains a challenge. First as larger populations of BE patients are studied the incidence of EAC arising from BE appears to be lower than previously thought.45 Second neither clinical characteristics nor tissue markers reliably predict the development of cancer in these patients; we are in effect looking for a needle in a haystack. Third cost-effectiveness analyses suggest that the number of BE patients needed to follow and treat to achieve a clear benefit is costly beyond the usual standards of what is considered cost-effective.46-48 Fourth without better predictive factors of cancer risk it would be difficult and extremely costly to perform a prospective study evaluating the effects of screening surveillance and treatment given the numbers of patients needed to follow. As a result it is more important than ever to use experts in the field to achieve consensus utilizing data from small clinical trials and numerous observational studies regarding the essentials of BE management in the absence of large clinical trials. Finally there are no published data on quality measure in BE patients. The Delphi process is one in which a.