National adoption of an esophageal cell collection device for Barrett’s esophagus surveillance: impact on delay to investigation and pathological findings

医学 巴雷特食管 发育不良 食管 内窥镜检查 恶性肿瘤 内科学 人口统计学的 胃肠病学 急诊分诊台 异型性 病态的 腺癌 病理 癌症 急诊医学 人口学 社会学
作者
Siobhan Chien,Paul Glen,Ian Penman,Gavin Bryce,Neil Cruickshank,Michael H. Miller,Andrew Crumley,Jonathan A. Fletcher,Perminder Phull,Ivan Gunjača,Kevin Robertson,Jeyakumar Apollos,Grant Fullarton
出处
期刊:Diseases of The Esophagus [Oxford University Press]
标识
DOI:10.1093/dote/doae002
摘要

Summary High quality Barrett’s esophagus surveillance is crucial to detect early neoplastic changes. An esophageal cell collection device (OCCD) was introduced as a triage tool for Barrett’s surveillance. This study aims to evaluate whether the Scottish OCCD program (CytoSCOT) has reduced delays to Barrett’s surveillance, and whether delayed surveillance negatively impacts endoscopic pathology. All patients undergoing OCCD testing for Barrett’s surveillance across 11 Scottish health boards between 14/9/2020 and 13/9/2022 were identified. Patients were dichotomised into two groups (Year 1 vs. Year 2), with individual records interrogated to record demographics, recommended surveillance interval, time from last endoscopy to OCCD test, and OCCD result. Patients were deemed high-risk if the OCCD demonstrated atypia and/or p53 positivity. Further analysis was performed on patients who underwent endoscopy within 12 months of OCCD testing. A total of 3223 OCCD tests were included in the analysis (1478 in Year 1; 1745 in Year 2). In Year 1 versus Year 2, there was a longer median delay to surveillance (9 vs. 5 months; P < 0.001), increased proportion of patients with delayed surveillance (72.6% vs. 57.0%; P < 0.001), and more high-risk patients (12.0% vs. 5.3%; P < 0.001). 425/3223 patients (13.2%) were further investigated with upper gastrointestinal endoscopy, 57.9% of which were high-risk. As surveillance delay increased beyond 24 months, high-risk patients were significantly more likely to develop dysplasia or malignancy (P = 0.004). Delayed Barrett’s esophagus surveillance beyond 24 months is associated with increased risk of pre-cancerous pathology. The CytoSCOT program has reduced delays in surveillance, promoting earlier detection of dysplasia and reducing burden on endoscopy services.

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