Evaluating the discrepancies between evidence-based and community standard practices in the endoscopic examination of Barrett’s esophagus: a nationwide survey in Japan

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BACKGROUND: Barrett's esophagus (BE) is a known precursor of esophageal adenocarcinoma (EAC). EAC is comparatively rare in Japan compared to Western countries, where BE management guidelines have been well established based on robust evidence. This study evaluated for gaps between evidence-based medicine (EBM) and real-world clinical practice for BE management in Japan and examined endoscopist adherence to Japanese and Western guidelines. METHODS: A nationwide survey consisting of 19 questions was conducted among Japanese endoscopists to assess their diagnostic and surveillance practices for BE. Descriptive statistics and multivariate logistic regression analysis were employed to interpret key data. RESULTS: Responses from 804 endoscopists revealed significant differences between Western guidelines and Japanese practices. Local adherence to standardized inspection times was 7.6%, and 30.7% of endoscopists used the Prague classification. Biopsies for BE diagnosis and random biopsies following the Seattle protocol were rarely performed. For long-segment BE, 51.4% of respondents reported using magnifying endoscopy. Regarding ultra-short-segment BE (USSBE), opinions were divided on whether it should be diagnosed as BE and if patients should be informed of its diagnosis. Approximately 40% of respondents advocated annual surveillance for USSBE, with a general tendency to recommend closer follow-up regardless of BE length as compared with Western guidelines. CONCLUSIONS: This survey highlighted several incongruities between EBM and real-world practices for BE, as well as differences between Western and Japanese approaches. Bridging these gaps will require generating more Japan-specific evidence, refining guidelines, and then promoting their dissemination to harmonize best BE practices with international standards and Japanese clinical settings.

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