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123 MANAGEMENT OF BARRETT'S ESOPHAGUS (BE) AND HIGH-GRADE DYSPLASIA (HGD): SURVEY OF CURRENT PRACTICES AMONG QUEBEC GASTROENTEROLOGISTS (GE) B Al Jarallah, S Mayrand Management of BE and, in particular HGD, remains somewhat controversial. Several competing therapeutic strategies are now available to clinicians, occasionally leading to confusion, despite widely disseminated guidelines.
McGill University Health Centre, Montreal, Quebec
AIMS: (1) To better determine the pivotal factors involved in the decision-making process concerning the management of BE and HGD. (2)To establish the level of general adherence to published guidelines in a sample of GE
METHOD: For this pilot study, 50 Quebec GE attending an international conference/CME activity were asked to fill out a questionnaire describing their usual practices and the factors driving their decision-making process in BE. Practice profiles/types, as well as various demographic informations were also collected.
RESULTS: Nineteen GE (38 %) completed our survey. Most of them (84%) systematically propose a surveillance program to their patients diagnosed with BE. The main reasons for not enrolling patients in a surveillance program were: patient's age, presence of significant comorbidity and poor patient's compliance. Only one GE considered the limited proven value of a surveillance program in itself, as the main reason for not enrolling patients in a surveillance program. The vast majority (79%) of those surveyed perform EGD every two years on their patients without dysplasia, while 21% perform EGD every three years or more. HGD is a rare finding, with most GE (63%) having identified only one to three cases over a three-year period, while 26% had not diagnosed any cases of HGD over the same period. The majority of GE (93%) systematically discuss nonsurgical alternatives with their patients with HGD. Sixty-three per cent of GE refer their patients with HGD for esophagectomy, while 19% prefer intensive endoscopic surveillance alone, 13% perform endoscopic mucosal resection (EMR) and 5% EMR + ablative therapy. Treatment effectiveness and safety were the most important factors guiding the therapeutic decision, followed by patient's age and preference and technology/expertise availability.
CONCLUSIONS: 1) Most GE surveyed enroll their BE patients in adequate surveillance programs. 2) Endoscopic ablative modalities have not yet had a significant impact on the management of HGD in routine practice, with esophagectomy being the preferred approach by most GE surveyed. 3) These findings will require confirmation by polling a larger sample of GE.
This study was supported by an unrestricted research grant from Axcan Pharma, St Hilaire, Quebec