Multinational survey on the preferred approach to management of Barrett’s esophagus in the Asia-Pacific region

Table 3 Survey results of respondents comparing Japan vs rest of Asia

Question	Option	Japan	Rest of Asia	P value
Q1. What is your preferred endoscopic landmark of the esophagogastric junction?	Squamo-columnar Junction (Z-line)	27.4%	59.5%	< 0.001
	Proximal margin of gastric folds	12.6%	27.8%
	Distal margin of palisade vessels	59.0%	10.0%
	Diaphragmatic pinch	1.0%	2.7%
Q2. What is your preferred endoscopic definition of Barrett’s esophagus?	Length of columnar lined epithelium ≥ 2 cm	23.2%	35.9%	< 0.001
	Length of columnar lined epithelium ≥ 1 cm	12.6%	34.7%
	Any length of columnar lined epithelium in the esophagus	64.2%	29.3%
Q3. How often do you use the Prague C and M criteria in your assessment of Barrett’s esophagus?	All the time	11.3%	22.4%	< 0.001
	> 70% of the time	4.5%	15.4%
	30%-70% of the time	8.7%	15.4%
	< 30% of the time	29.4%	30.9%
	Never	46.1%	15.8%
Q4. How comfortable are you with endoscopic assessment (white-light with or without advanced imaging technology) in the diagnosis of Barrett’s esophagus?	100% comfortable	17.1%	8.1%	< 0.001
	> 70% comfortable	51.6%	37.5%
	30%-70% comfortable	24.2%	34.4%
	< 30% comfortable	6.5%	15.4%
	Not at all	0.6%	4.6%
Q5. What is your preferred histologic definition of Barrett’s esophagus?	Any columnar tissue	35.2%	39.4%	< 0.001
	Specialized intestinal metaplasia	16.8%	36.3%
	Gastric metaplasia	16.1%	18.9%
	No histological confirmation required	31.9%	5.4%
Q6. In your practice, how regular do you survey your long-segment Barrett’s esophagus without dysplasia?	Every 2 yr	82.3%	57.1%	< 0.001
	Every 3 yr	4.8%	22.8%
	Every 5 yr	1.6%	4.6%
	None at all	11.3%	15.4%
Q7. How often do you follow the Seattle protocol (i.e. four-quadrant biopsies every 2 cm) in your biopsies of Barrett’s esophagus during surveillance endoscopy?	All the time	2.6%	10.8%	< 0.001
	> 70% of the time	4.2%	8.1%
	30%-70% of the time	2.3%	17.4%
	< 30% of the time	17.7%	44.4%
	Never	73.2%	19.3%
Q8. What is your preferred treatment of Barrett’s esophagus without dysplasia?	Lifelong PPI	15.8%	27.8%	< 0.001
	PPI only when patient has symptoms of gastroesophageal reflux or evidence of esophagitis	81.9%	64.5%
	Radiofrequency Ablation	1.0%	3.9%
	Anti-reflux procedure (e.g. fundoplication)	1.3%	3.9%
Q9. For Barrett’s esophagus patients whose biopsies showed indefinite for dysplasia, your preferred approach is:	Confirm with second pathologist and repeat endoscopy after a course of PPI	32.6%	59.5%	< 0.001
	Surveillance 6-monthly	37.7%	21.2%
	Surveillance yearly	29.0%	18.1%
	Surveillance 3-5 yearly	0.6%	1.2%
Q10. For Barrett’s esophagus patients without a lesion but whose biopsies showed low grade dysplasia, your preferred approach is:	Surveillance 6-monthly	61.9%	47.9%	< 0.001
	Surveillance yearly	21.9%	20.5%
	Surveillance 3-5 yearly	1.0%	2.7%
	Ablative therapy, e.gv., radiofrequency, cryotherapy, argon plasma coagulation	1.0%	19.7%
	Endoscopic mucosal resection	1.6%	6.6%
	Endoscopic submucosal dissection	12.6%	2.7%
Q11. For Barrett’s esophagus patients without a lesion but whose biopsies showed high grade dysplasia, your preferred treatment is:	Endoscopic mucosal resection	12.6%	22.4%	< 0.001
	Endoscopic submucosal dissection	83.5%	49.8%
	Ablative therapy, e.g., radiofrequency, cryotherapy, argon plasma coagulation	2.6%	21.6%
	Surgery, e.g., esophagectomy	1.3%	6.2%

PPI: Proton pump inhibitor.