The 4th Joint Session between JDDW-KDDW-TDDW2(JDDW)
Thu. November 5th   14:00 - 16:15   Room 9: Portopia Hotel Main Building Kairaku 3
JKT2-3
 Current diagnosis and endoscopic therapy of Barrett esophagus in Taiwan - A multi-center survey
Ching-Tai Lee
Department of Endoscopy, E-Da Hospital and I-Shou University
Although Barrett esophagus (BE) is an uncommon diagnosis in Taiwan, adenocarcinoma due to progression of BE remained a problem not to be ignored. In the past decades, the incidence of BE increased gradually in proportional to that of reflux esophagitis. In 2016, Asia-Pacific consensus on the management of GERD and BE was revised; however, the diagnosis and endoscopic therapy of BE are still challenging in Taiwan. Standardization of diagnosis and management for BE are crucial.
In early July 2020, one-day conference for a multi-center survey focusing on current diagnosis and endoscopic therapy of BE was done on behalf of the digestive endoscopy society of Taiwan (DEST). Sixty endoscopists with specialization of BE attended the meeting. Pre questionnaire surveys of the current status about the diagnosis and endoscopic therapy of BE in Taiwan were taken. After pre questionnaire surveys, literature reviews of currently updated guidelines were performed by experts, including American College of Gastroenterology (ACG), the American Gastroenterological Association (AGA), British Society of Gastroenterology (BSG), Japan Esophageal Society (JES), Asia-Pacific consensus, and European Society of Gastrointestinal Endoscopy (ESGE). After literature reviews, the post questionnaire surveys with similar questions were performed followed by detail discussion.
Only half participants agreed IM as an essential feature for the diagnosis of BE. However, IM was regarded as a diagnostic criteria of BE by pathologists in real world practice. This remained the major dispute in Taiwan. Seldom endoscopists followed the Seattle protocol but almost all participants preferred to use Plaque C & M criteria to describe the extension of BE. Controversies existed between the top of gastric fold and lower border of palisading vessel as a landmark of ECJ. Participants suggested proton-pump inhibitor for non-dysplastic Barrett patients with reflux-related symptoms. More than one third participants would like to take aggressive measures to manage BE with low-grade dysplasia. Endoscopic resection still is the 1st choice of treatment for Barrett mucosa with high-grade dysplasia. Additional therapy with radio-frequency ablation (RFA) for remaining Barrett mucosa is strongly recommended after eradication of dysplastic part.
This survey demonstrated the real-world condition of the diagnosis and treatment for Barrett disease in Taiwan. Further communication between the endoscopists and the pathologists will be arranged to make a consensus by DEST in the future.
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