Quality Indicators in Endoscopic Ablation for Barrett’s Esophagus
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Barrett’s esophagus (BE) is a well-established premalignant condition for esophageal adenocarcinoma (EAC); a cancer that is associated with a poor 5-year survival rate. Several strategies have been explored in the context of reducing the burden of EAC. Endoscopic eradication therapy (EET) is considered the standard of care for the management of patients with BE with dysplasia and early neoplasia; a practice that has been endorsed by all gastroenterology societal guidelines. The effectiveness of EET has been demonstrated in multiple studies and contemporary management includes a combination of endoscopic mucosal resection (EMR) of all visible lesions followed by eradication of the remaining BE using ablative techniques of which radiofrequency ablation (RFA) has the best evidence supporting effectiveness and safety. These techniques are being used increasingly at academic tertiary care centers and community practices. In this era of value-based health care, there is increased focus on the establishment, documentation, and reporting of quality indicators; indicators that are important to physicians, patients, and payers. The purpose of this review is to highlight the current status of quality indicators in EET for the management of patients with BE-related neoplasia and discuss the future steps required to ensure that these quality indicators are uniformly incorporated into practice.
KeywordsQuality indicators Barrett’s esophagus Endoscopic eradication therapy Endoscopic ablation Radiofrequency ablation
Endoscopic eradication therapy
Endoscopic mucosal resection
High grade dysplasia
American Gastroenterological Association
American Society for Gastrointestinal Endoscopy
American College of Gastroenterology
RAND/University of California, Los Angeles Appropriateness Methodology
High definition white light endoscopy
Complete eradication of intestinal metaplasia
Complete eradication of neoplasia
This work was supported by the University of Colorado, Department of Medicine Outstanding Early Scholars Program (SW).
Compliance with Ethical Standards
Conflict of Interest
Samuel Han declares no conflict of interest.
Sachin Wani reports grants from University of Colorado, Department of Medicine Outstanding Early Scholars Program and consultancy fees from Boston Scientific and Medtronic.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommented Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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