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

BackgroundCurrent 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.ObjectiveTo evaluate the impact of Barrett's inspection time (BIT) on yield of surveillance.DesignPost hoc analysis of data obtained from a clinical trial.SettingFive tertiary referral centers.PatientsPatients undergoing BE surveillance.InterventionsCoordinators prospectively recorded the time spent inspecting the BE mucosa with a stopwatch.Main Outcome MeasurementsEndoscopically suspicious lesions, high-grade dysplasia (HGD)/esophageal adenocarcinoma (EAC).ResultsA 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 (ρ = .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).LimitationsPost hoc analysis of an enriched study population and experienced endoscopists at tertiary referral centers.ConclusionsLonger 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.