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  • Estimating neoplasia detection rate (NDR) in patients with Barrett’s oesophagus based on index endoscopy: a systematic review and meta-analysis

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Oesophagus
Original article
Estimating neoplasia detection rate (NDR) in patients with Barrett’s oesophagus based on index endoscopy: a systematic review and meta-analysis
  1. Sravanthi Parasa1,
  2. Madhav Desai2,
  3. Anusha Vittal3,
  4. Viveksandeep T Chandrasekar3,
  5. Asad Pervez3,
  6. Kevin F Kennedy4,
  7. Neil Gupta5,
  8. Nicholas J Shaheen6,
  9. Prateek Sharma7
  1. 1 Gastroenterology, Swedish Medical Group, Seattle, Washington, USA
  2. 2 Department of Gastroenterology, University of Kansas Medical Center, Kansas City, Kansas, USA
  3. 3 Department of Gastroenterology, KUMC, Kansas City, Kansas, USA
  4. 4 Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
  5. 5 Department of Gastroenterology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
  6. 6 Department of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
  7. 7 Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Kansas, USA
  1. Correspondence to Professor Prateek Sharma, University Of Kansas, Kansas KC 64128, USA; psharma{at}kumc.edu

Abstract

Background Biopsies are obtained to confirm intestinal metaplasia and rule out prevalent dysplasia and cancer when Barrett’s oesophagus (BE) is detected at index upper endoscopy (oesophagogastroduodenoscopy [EGD]).

Aim The purpose of this systematic review was to obtain summary estimates of the prevalence of high-grade dysplasia (HGD) and oesophageal adenocarcinoma (EAC) associated with BE during index EGD for chronic GERD symptoms, defined as neoplasia detection rate (NDR) which could be used as a quality measure.

Methods An extensive search was performed within PUBMED, EMBASE and the Cochrane Library databases to identify studies in which patients underwent index endoscopy for the evaluation of the presence of BE. Two reviewers independently evaluated both the study eligibility and methodological quality and data extraction. A random-effects model (REM) based on the binomial distribution was used to calculate the pooled effects of the prevalence of BE-associated dysplasia and EAC.

Results For the calculation of dysplasia and EAC prevalence rates, a total of 11 studies with 10 632 patients met the inclusion criteria including 80.4% men with a mean age of 58.7 years and average BE length of 3.5 cm. The pooled prevalence of EAC, HGD and LGD was 3%(95% CI 2 to 5, 9 studies: 396/10 539 patients), 3%(95% CI 2 to 5 [REM], 9 studies: 388/10 539 patients) and 10%(95% CI 7 to 15 [REM], 10 studies: 907/8945 patients), respectively. For NDR, that is, the pooled prevalence of HGD/EAC was 7%(95% CI 4 to 10 [REM], 10 studies: 795/10 632 patients).

Conclusion NDR is approximately 4% and could be used as a quality measure.

  • barrett’s oesophagus
  • oesophageal cancer
  • barrett’s metaplasia
  • gastroesophageal reflux disease

https://doi.org/10.1136/gutjnl-2018-317800

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    Footnotes

    • Contributors SP: concept and design, interpretation of results and drafting the manuscript. MD: data collection and critical revision of the manuscript for intellectual content. AV: critical revision of the manuscript for intellectual content. AP: data collection and critical revision of the manuscript for intellectual content. VTC: data collection. KFK: statistical analysis. NG: critical revision of the manuscript for intellectual content. NJS: critical revision of the manuscript for intellectual content. PS: concept and design, interpretation of the results and drafting manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      No funding for this project

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.