PDF(Pubmed)
Abstract：
BACKGROUND: Barrett\'s oesophagus surveillance places significant burden on endoscopy services yet is vital to detect early cancerous change. Oesophageal cell collection device (OCCD) testing was introduced across Scotland for Barrett\'s surveillance in response to the COVID-19 pandemic. This national pragmatic retrospective study presents the CytoSCOT programme results and evaluates whether OCCD testing is successfully identifying high-risk Barrett\'s patients requiring urgent endoscopy.
METHODS: All patients undergoing OCCD testing for Barrett\'s surveillance across 11 Scottish health boards over a 32-month period were identified. Patients who underwent endoscopy within 12 months of OCCD test were included. Individual patient records were interrogated to record clinical information and OCCD test result to categorize patients into risk groups. Endoscopic histopathology results were analysed according to risk group and segment length. Patients were deemed high risk if the OCCD test demonstrated atypia and/or p53 positivity.
RESULTS: 4204 OCCD tests were performed in 3745 patients: 608 patients underwent endoscopy within 12 months and were included in this analysis. Patients with longer Barrett\'s segments were significantly more likely to have an abnormal OCCD test. 50/608 patients (8.2%) had high-grade dysplasia or cancer on endoscopic biopsies: this equates to 1.3% of the total group (50/3745). 46/50 patients (92.0%) were deemed high risk, triggering urgent endoscopy: this rose to 100% with insufficient tests removed. There were no cancers diagnosed within 12 months post-OCCD in the low-risk group.
CONCLUSIONS: OCCD testing is an effective triage tool to identify high-risk patients with Barrett\'s oesophagus requiring further investigation with endoscopy within the real-world setting.
METHODS: All patients undergoing OCCD testing for Barrett\'s surveillance across 11 Scottish health boards over a 32-month period were identified. Patients who underwent endoscopy within 12 months of OCCD test were included. Individual patient records were interrogated to record clinical information and OCCD test result to categorize patients into risk groups. Endoscopic histopathology results were analysed according to risk group and segment length. Patients were deemed high risk if the OCCD test demonstrated atypia and/or p53 positivity.
RESULTS: 4204 OCCD tests were performed in 3745 patients: 608 patients underwent endoscopy within 12 months and were included in this analysis. Patients with longer Barrett\'s segments were significantly more likely to have an abnormal OCCD test. 50/608 patients (8.2%) had high-grade dysplasia or cancer on endoscopic biopsies: this equates to 1.3% of the total group (50/3745). 46/50 patients (92.0%) were deemed high risk, triggering urgent endoscopy: this rose to 100% with insufficient tests removed. There were no cancers diagnosed within 12 months post-OCCD in the low-risk group.
CONCLUSIONS: OCCD testing is an effective triage tool to identify high-risk patients with Barrett\'s oesophagus requiring further investigation with endoscopy within the real-world setting.
摘要：
背景：Barrett的食道监测给内窥镜检查服务带来了巨大负担，但对于检测早期癌变至关重要。针对COVID-19大流行，在苏格兰各地引入了食道细胞收集装置（OCCD）测试，用于Barrett的监测。这项全国性的务实回顾性研究介绍了CytoSCOT计划的结果，并评估了OCCD测试是否成功地识别了需要紧急内窥镜检查的高风险Barrett患者。
方法：确定了在32个月内对11个苏格兰卫生委员会进行OCCD检测以进行Barrett监测的所有患者。包括在OCCD测试的12个月内接受内窥镜检查的患者。询问单个患者记录以记录临床信息和OCCD测试结果，以将患者分为风险组。根据风险组和节段长度分析内镜组织病理学结果。如果OCCD测试显示异型和/或p53阳性，则患者被认为是高风险的。
结果：对3745例患者进行了4204次OCCD测试：608例患者在12个月内接受了内窥镜检查，并被纳入本分析。Barrett节段较长的患者OCCD检测异常的可能性更大。50/608例患者（8.2％）在内镜活检中患有高度异型增生或癌症：这相当于总组的1.3％（50/3745）。46/50的患者（92.0%）被认为是高风险，触发紧急内窥镜检查：在排除测试不足的情况下，这一比例上升到100％。在低风险组中，在OCCD后12个月内没有诊断出癌症。
结论：OCCD检测是一种有效的分诊工具，可用于识别Barrett食管高危患者，需要在现实环境中进行进一步的内窥镜检查。
方法：确定了在32个月内对11个苏格兰卫生委员会进行OCCD检测以进行Barrett监测的所有患者。包括在OCCD测试的12个月内接受内窥镜检查的患者。询问单个患者记录以记录临床信息和OCCD测试结果，以将患者分为风险组。根据风险组和节段长度分析内镜组织病理学结果。如果OCCD测试显示异型和/或p53阳性，则患者被认为是高风险的。
结果：对3745例患者进行了4204次OCCD测试：608例患者在12个月内接受了内窥镜检查，并被纳入本分析。Barrett节段较长的患者OCCD检测异常的可能性更大。50/608例患者（8.2％）在内镜活检中患有高度异型增生或癌症：这相当于总组的1.3％（50/3745）。46/50的患者（92.0%）被认为是高风险，触发紧急内窥镜检查：在排除测试不足的情况下，这一比例上升到100％。在低风险组中，在OCCD后12个月内没有诊断出癌症。
结论：OCCD检测是一种有效的分诊工具，可用于识别Barrett食管高危患者，需要在现实环境中进行进一步的内窥镜检查。
