Published online Apr 15, 2021. doi: 10.4251/wjgo.v13.i4.279
Peer-review started: November 8, 2020
First decision: December 17, 2020
Revised: December 31, 2020
Accepted: March 10, 2021
Article in press: March 10, 2021
Published online: April 15, 2021
Major societies provide differing guidance on management of Barrett’s esophagus (BE), making standardization challenging.
To evaluate the preferred diagnosis and management practices of BE among Asian endoscopists.
Endoscopists from across Asia were invited to participate in an online questionnaire comprising eleven questions regarding diagnosis, surveillance and management of BE.
Five hundred sixty-nine of 1016 (56.0%) respondents completed the survey, with most respondents from Japan (n = 310, 54.5%) and China (n = 129, 22.7%). Overall, the preferred endoscopic landmark of the esophagogastric junction was squamo-columnar junction (42.0%). Distal palisade vessels was preferred in Japan (59.0% vs 10.0%, P < 0.001) while outside Japan, squamo-columnar junction was preferred (59.5% vs 27.4%, P < 0.001). Only 16.3% of respondents used Prague C and M criteria all the time. It was never used by 46.1% of Japanese, whereas 84.2% outside Japan, endoscopists used it to varying extents (P < 0.001). Most Asian endoscopists (70.8%) would survey long-segment BE without dysplasia every two years. Adherence to Seattle protocol was poor with only 6.3% always performing it. 73.2% of Japanese never did it, compared to 19.3% outside Japan (P < 0.001). The most preferred (74.0%) treatment of non-dysplastic BE was proton pump inhibitor only when the patient was symptomatic or had esophagitis. For BE with low-grade dysplasia, 6-monthly surveillance was preferred in 61.9% within Japan vs 47.9% outside Japan (P < 0.001).
Diagnosis and management of BE varied within Asia, with stark contrast between Japan and outside Japan. Most Asian endoscopists chose squamo-columnar junction to be the landmark for esophagogastric junction, which is incorrect. Most also did not consistently use Prague criteria, and Seattle protocol. Lack of standardization, education and research are possible reasons.
Core Tip: Presently, not all guidelines agree on the management of Barrett's esophagus (BE). It is against this background that the Asian Barrett's Consortium conducted this multinational survey, which involved 569 endoscopists from 13 countries/regions, and we found that management of BE varied, with stark contrast between participants from Japan and the rest of Asia-Pacific. Most endoscopists chose squamo-columnar junction to be the landmark for esophagogastric junction, which is incorrect. Most also did not consistently use Prague criteria, and Seattle protocol. We believe that these findings will shape our future efforts to standardize the management approach of this condition.