Barrett’s esophagus is sometimes complicated by high grade dysplasia. This survey was designed to inform readers about current practices in surveillance for and management of this problem. For purposes of this survey, respondents were asked to assume that they were referred a healthy middle aged patient who had been diagnosed with Barrett’s esophagus. The patient had undergone endoscopy by a gastroenterologist showing no evidence for cancer, and reflux symptoms were well controlled on acid suppression therapy.

The number of respondents was low, suggesting that most readers are not actively managing patients with Barrett’s esophagus. Of those responding, the majority are involved in managing such patients. It is widely believed among respondents that antireflux surgery reduces the risk of high grade dysplasia developing in Barrett’s mucosa. All respondents agree on the need for endoscopic surveillance in patients with Barrett’s esophagus. There is considerable disagreement regarding the likelihood of invasive cancer being present when HGD is diagnosed, with more than 50% of respondents believing the risk is 20% or less. Repeat endoscopy and EUS are the most common procedures recommended when HGD is identified. For patients with confirmed HGD, two-thirds of respondents believe esophagectomy is the appropriate therapy, which is in contrast to the fact that most respondents believe the risk of cancer is less than 20%.

1. Do you manage patients with Barrett's esophagus?
	answered question		42
	skipped question		0
		Response Percent	Response Count
Yes		83.3%	35
No		16.7%	7

2. Do you believe that fundoplication surgery can help prevent the development of high grade dysplasia in Barrett's mucosa?
	answered question		42
	skipped question		0
		Response Percent	Response Count
Yes		64.3%	27
No		35.7%	15

3. Should patients with Barrett's esophagus undergo surveillance endoscopy periodically?
	answered question		42
	skipped question		0
		Response Percent	Response Count
Yes		100.0%	42
No		0.0%	0

4. When high grade dysplasia is identified in Barrett's mucosa, what is the likelihood that a patient will have invasive adenocarcinoma at that point in time?
	answered question		42
	skipped question		0
		Response Percent	Response Count
10%		26.2%	11
20%		26.2%	11
30%		23.8%	10
40% or more		23.8%	10

5. If Barrett's high grade dysplasia is identified, check all tests or procedures you normally use for further evaluation at the time of diagnosis:
	answered question		42
	skipped question		0
		Response Percent	Response Count
Repeat endoscopy (including any associated techniques such as chromoendoscopy, high resolution endoscopy, etc.)		33.3%	14
CT scan		14.3%	6
PET scan		11.9%	5
EUS		33.3%	14
EMR		7.1%	3

6. If Barrett's high grade dysplasia is confirmed and the patient is healthy, what do you most often recommend for initial management?
	answered question		42
	skipped question		0
		Response Percent	Response Count
Esophagectomy		66.7%	28
EMR or other ablative procedure		19.0%	8
Observation with close surveillance		14.3%	6

7. In what region is your surgical practice based?
	answered question		42
	skipped question		0
		Response Percent	Response Count
North America		61.9%	26
Europe		26.2%	11
South America		0.0%	0
Asia		7.1%	3
Africa		4.8%	2