Adherence to Barrett’s esophagus surveillance guidelines and its impact on progression: a multicenter prospective study

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Abstract
Adherence to surveillance recommendations for Barrett’s esophagus (BE) has been little studied. This study evaluated adherence to current guidelines in Spain, factors associated with deviations from recommendations, and the impact on progression. It was a prospective, observational, multicenter study of patients with BE between January 2016 and December 2022. 375 patients (80.5% males, age 55 ± 13 years) were followed for 50 (IQR 34–61) months and underwent 556 gastroscopies, 505(90.8%) for surveillance. Among these, only 206(40.8%) were performed within the recommended intervals and 254(50.3%) were early endoscopies. Risk factors for early endoscopy were short BE length (< 3 cm 59.5% vs. ≥ 3 cm 42.2%, OR 2.01(1.35–2.98)) and endoscopy referred by a surgeon (7.2% vs. 2.8%, OR 2.99(1.19–7.52)), whereas use of the Seattle protocol (68% vs 79.9%, OR 0.51(0.32–0.8)) was protective. BE progression was confirmed in 13 patients (3.4%): 7 low-grade dysplasia, 5 high-grade dysplasia or in-situ adenocarcinoma, and 1 invasive adenocarcinoma. The median time from BE diagnosis to progression was 48 months (IQR 28–59). Early endoscopy did not significantly increased detection of BE progression (3.1% vs 2%, p = 0.41). The only independent risk factor for progression was BE length (OR 9.39 (2.02–43.78)). In conclusion, adherence to BE surveillance guidelines in Spain is low and the tendency to early endoscopy is notable. Improving adherence could reduce unnecessary procedures without compromising patient outcomes.

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