Table 5.

Appropriate postprocedure QIs after round 2 voting with the median score, MAD-M, BIOMED analysis, p value, IPRAS analysis and the performance threshold

Postprocedure QIs	Median score	MAD-M	BIOMED analysis	P value	IPRAS analysis	Performance threshold, median % (range)
Following successful BET, patients undergo follow-up endoscopies at appropriate intervals stratified according to risk of recurrence.	9	0.6	No disagreement	1	No disagreement	90 (80–100)
Aspirational performance target: 90% (range: 80–100). Evidence summary: ET does not eliminate the need for continued endoscopic surveillance or completely eliminate the risk of synchronous or metachronous disease. Particular concern remains over IM, which is buried under the neosquamous epithelium after ET. This is a rare but recognised finding. The identification of these cases indicates the need for continued surveillance following RFA therapy, even after CR-IM. Increasing age and length of BE segment are associated with a longer time to achieve CR-IM. It is therefore essential to continue surveillance after RFA. By dividing patients into simple categories, clinicians may stratify risk to choose the appropriate surveillance regimen. A large prospective study by Shaheen et al 25 has shown impressive CR-D and CR-IM rates at 2 years (CR-D 95% and CR-IM 93%) and 3 years (CR-D 98% and CR-IM 91%) post initial BET with an annual rate of neoplastic progression of 1.37% per patient-years.25 Phoa et al 35 also showed a 90% remission at 5 years post-BET.35 The UK RFA registry has demonstrated a risk of neoplasia recurrence of 19% at 5 years with a predicted risk of IM recurrence of 13% at 26 months and a 32% risk of IM recurrence at 5 years.3 The literature supports an IM/neoplasia recurrence rate between 10% and 32% at 5 years. Therefore, follow-up postendoscopic therapy of BE neoplasia is needed to exclude recurrence and to deliver further therapy as needed.2 A recent study by Cotton et al 36 provided evidence-based surveillance intervals after completion of ET in patients with BE neoplasia. For patients with LGD the group proposed surveillance endoscopy at 1 and 3 years after achieving CR-IM with ET. For patients with HGD or IMC, the proposed surveillance endoscopy was at 3 months, 6 months and 1 year and then annually (for 5 years) after achieving CR-IM with ET.36 Based on recent evidence, our expert panel felt that it would be reasonable to consider endoscopic follow-up proposed by Cotton et al.36
At follow-up endoscopy, biopsies should be taken from the squamocolumnar junction and within the extent of the original BE length, for the first 2 years; thereafter, biopsies should be taken from the squamocolumnar junction and any visible lesion.	8	0.6	No disagreement	1	No disagreement	90 (80–100)
Aspirational performance target: 90% (range: 80–100). Evidence summary: Adherence to biopsy protocol will significantly increase the detection rate of dysplasia in patients with BE. IM can reoccur at the gastro-oesophageal junction in the absence of visible BE following the successful eradication of BE neoplasia. Recent studies have suggested evidence of buried glands post-BET in 5.5%–7% of patients, but the majority of these were not detectable at subsequent endoscopies.37 Our expert panel suggests that endoscopic follow-up should include biopsies at the GOJ and within the previous extent of the BE epithelium.2 This should include a high-resolution gastroscope to assess the treated and remaining area of BE.5 In order to exclude synchronous neoplastic lesions, four-quadrant biopsies should be performed at 1–2 cm intervals throughout the entire BE segment.5

BE, Barrett’s oesophagus; BET, Barrett’s endotherapy; CR-D, complete remission of dysplasia; CR-IM, complete remission of intestinal metaplasia; ET, endoscopic therapy; GOJ, gastro oesophageal junction; HGD, high grade dysplasia; IM, intestinal metaplasia; IMC, intramucosal carcinoma; IPRAS, interpercentile range adjusted for symmetry; LGD, low grade dysplasia; MAD-M, mean absolute deviation from the median; QI, quality indicator; RFA, radiofrequency ablation.