Longer inspection time is associated with increased detection of high-grade dysplasia and esophageal adenocarcinoma in Barrett's esophagus

Background: Current guidelines recommend that endoscopic surveillance of Barrett's esophagus (BE) be performed by using a strict biopsy protocol. However, novel methods to improve BE surveillance are still needed. Objective: To evaluate the impact of Barrett's inspection time (BIT) on yield of surveillance. Design: Post hoc analysis of data obtained from a clinical trial. Setting: Five tertiary referral centers. Patients: Patients undergoing BE surveillance. Interventions: Coordinators prospectively recorded the time spent inspecting the BE mucosa with a stopwatch. Main Outcome Measurements: Endoscopically suspicious lesions, high-grade dysplasia (HGD)/esophageal adenocarcinoma (EAC). Results: A total of 112 patients underwent endoscopic surveillance by 11 individual endoscopists. Patients with longer BITs were more likely to have an endoscopically suspicious lesion (P < .001) and more endoscopically suspicious lesions (P = .0001) and receive a diagnosis of HGD/EAC (P = .001). There was a direct correlation between the endoscopist's mean BIT per centimeter of BE and the detection of patients with HGD/EAC (rho = .63, P = .03). Endoscopists who had an average BIT longer than 1 minute per centimeter of BE detected more patients with endoscopically suspicious lesions (54.2% vs 13.3%, P = .04), and there was a trend toward a higher detection rate of HGD/EAC (40.2% vs 6.7%, P = .06). Limitations: Post hoc analysis of an enriched study population and experienced endoscopists at tertiary referral centers. Conclusions: Longer time spent inspecting the BE segment is associated with the increased detection of HGD/EAC. Taking additional time to perform a thorough examination of the BE mucosa may serve as an easy and widely available method to improve the yield of BE surveillance. (Gastrointest Endosc 2012;76:531-8.)