Impact of expert center endoscopic assessment of confirmed low grade dysplasia in Barrett’s esophagus diagnosed in community hospitals

Background and study aims Optimal management for patients with low-grade dysplasia (LGD) in Barrett's esophagus (BE) is unclear. According to our national guideline, all patients with LGD with histologic confirmation of the diagnosis by an expert pathologist (i.e. "confirmed LGD"), are referred for a dedicated re-staging endoscopy in an expert center. We aimed to assess the diagnostic value of re-staging endoscopy by an expert endoscopist for patients with confirmed LGD. Methods In this retrospective cohort study, we included all patients with flat BE diagnosed in a community center who had confirmed LGD and were referred to one of the nine Barrett expert centers (BEC) in the Netherlands. Primary outcome was the proportion of patients with prevalent high-grade dysplasia (HGD) or cancer during re-staging in a BEC. Results Of the 248 patients with confirmed LGD, re-staging in the BEC revealed HGD or cancer in 23% (57/248). In 79% (45/57), HGD or cancer in a newly detected visible lesion was diagnosed. Of the remaining patients, re-staging in the BEC showed a second diagnosis of confirmed LGD in 68% (168/248), while the remaining 9% (23/248) had non-dysplastic BE. Conclusion One quarter of patients with apparent flat BE with confirmed LGD diagnosed in a community hospital turns out to have prevalent HGD or cancer after re-staging in an expert center. This endorses the advice to refer patients with confirmed LGD - also in the absence of visible lesions - to an expert center for re-staging endoscopy