Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Apr 15, 2021; 13(4): 279-294
Published online Apr 15, 2021. doi: 10.4251/wjgo.v13.i4.279
Multinational survey on the preferred approach to management of Barrett’s esophagus in the Asia-Pacific region
Guan Sen Kew, Alex Yu Sen Soh, Yeong Yeh Lee, Takuji Gotoda, Yan-Qing Li, Yan Zhang, Yiong Huak Chan, Kewin Tien Ho Siah, Daniel Tong, Simon Ying Kit Law, Andrew Ruszkiewicz, Ping-Huei Tseng, Yi-Chia Lee, Chi-Yang Chang, Duc Trong Quach, Chika Kusano, Shobna Bhatia, Justin Che-Yuen Wu, Rajvinder Singh, Prateek Sharma, Khek-Yu Ho
Guan Sen Kew, Kewin Tien Ho Siah, Department of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System, Singapore 119228, Singapore
Alex Yu Sen Soh, Department of Gastroenterology and Hepatology, National University Hospital, National University Health System, Singapore 119074, Singapore
Yeong Yeh Lee, School of Medical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia
Takuji Gotoda, Chika Kusano, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
Yan-Qing Li, Yan Zhang, Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
Yiong Huak Chan, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
Daniel Tong, Simon Ying Kit Law, Department of Surgery, The University of Hong Kong, Hong Kong Pokfulam, Hong Kong, China
Andrew Ruszkiewicz, Department of Pathology, SA Pathology, Adelaide 5112, Australia
Ping-Huei Tseng, Yi-Chia Lee, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
Chi-Yang Chang, Department of Internal Medicine, Fu Jen Catholic University Hospital, Taipei 24352, Taiwan
Duc Trong Quach, Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City, Vietnam, Hochiminh 70000, Viet Nam
Shobna Bhatia, Department of Gastroenterology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai 400012, India
Justin Che-Yuen Wu, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
Rajvinder Singh, Department of Gastroenterology, Lyell McEwin Hospital, University of Adelaide, Adelaide 64128, Australia
Prateek Sharma, Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, KS 64128, United States
Khek-Yu Ho, Department of Medicine, National University Hospital, Singapore 119074, Singapore
Author contributions: Lee YY, Gotoda T and Ho KY came up with the study and conception; Soh AYS collected the data; Kew GS, Soh AYS, and Chan YH analysed and interpreted the results; Kew GS and Soh AYS drafted the initial manuscript; all authors reviewed the results and approved the final version of the manuscript.
Institutional review board statement: Ethics approval was obtained for this study, No. DSRB 2018/00863.
Informed consent statement: Survey respondents have given their consent to participate in the study when they complete the questionnaire.
Conflict-of-interest statement: The authors report no conflict of interest in the study.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Khek-Yu Ho, FRCP, MBBS, MRCP, Professor, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. mdchoky@nus.edu.sg
Received: November 8, 2020
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
Research background

Barrett’s esophagus (BE), a premalignant condition, is associated with increased risk of esophageal adenocarcinoma. However, major societies provide differing guidance on management of BE, making standardization challenging.

Research motivation

The Asian Barrett’s Consortium was founded in 2008 to develop strategies in tackling challenges faced in the management of BE in the Asia. The group previously reported that there was substantial variability in the published prevalence of BE in Asia, noting that these studies used different methodologies, enrolled populations, endoscopic practices and histopathological criteria. To further our efforts to improve our management of BE, we wanted to understand the varying management practices of endoscopists from various countries in Asia.

Research objectives

The study aimed to evaluate the preferred diagnosis and management practices of Asian endoscopists on BE. The findings will shape our future efforts to standardize the management approach of this condition.

Research methods

An online survey comprising 11 questions, was distributed to gastrointestinal endoscopists from countries across Asia from July 2018 to July 2019. The survey questions were categorized to “preferred diagnosis and surveillance practice” and “preferred management approach”.

Research results

The study found that 42.0% of all endoscopists incorrectly used the squamo-columnar junction to identify the esophagogastric junction. Prague C and M criteria was seldomly used by endoscopists, and adherence to Seattle protocol was poor with only 6.3% always performing it. There were also differences in diagnosis and management of BE when comparing endoscopists within Japan and outside Japan.

Research conclusions

Diagnosis and management of BE varied within Asia, with stark contrast between Japan and outside Japan. Lack of standardization, education and research are possible reasons to account for such differences.

Research perspectives

Further research is required to identify reasons for non-adherence to certain protocols in the management of BE, and how we could attempt to standardize diagnosis and management of BE.