INTRODUCTION Barrett's esophagus (BE) is a precursor to esophageal adenocarcinoma (EAC). Physicians infrequently adhere to guidelines for managing BE, leading to either reduced detection of dysplasia or inappropriate re-evaluation. METHODS We conducted a three-arm randomized controlled trial with two intervention arms to determine the impact of a tissue systems pathology (TSP-9) test on the adherence to evidence-based guidelines for simulated patients with BE. Intervention 1 received TSP-9 results and intervention 2 had the option to order TSP-9 results. We collected data from 259 practicing gastroenterologists and gastrointestinal surgeons who evaluated and made management decisions for 3 simulated BE patient types: non-dysplastic BE, indefinite for dysplasia, and low-grade dysplasia. RESULTS Intervention 1 was significantly more likely to correctly assess risk of progression to HGD/EAC and offer treatment in accordance with U.S. society guidelines versus control (+6.9%, 95% CI +1.4% to +12.3%). There was no significant difference in ordering guideline-recommended endoscopic eradication therapy. However, for cases requiring annual endoscopic surveillance, we found significant improvement in adherence for intervention 1, with a difference-in-difference of +18.5% (p=0.019). Intervention 2 ordered the TSP-9 test in 21.9% of their cases. Those who ordered the test performed similarly to intervention 1; those who did not, performed similarly to the control group. DISCUSSION The TSP-9 test optimized adherence to clinical guidelines for surveillance and treatment of both BE patients at high and low risk for disease progression. Use of the TSP-9 test can enable physicians to make risk-aligned management decisions, leading to improved patient health outcomes.

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关于巴雷特食管模拟患者管理中临床遵守循证指南以及组织系统病理学测试的临床效用的随机对照研究：Q-TAB 结果。

简介 巴雷特食管 (BE) 是食管腺癌 (EAC) 的前兆。医生很少遵守 BE 管理指南，导致不典型增生的检测减少或重新评估不当。方法 我们进行了一项包含两个干预组的三组随机对照试验，以确定组织系统病理学 (TSP-9) 测试对模拟 BE 患者遵守循证指南的影响。干预 1 收到了 TSP-9 结果，干预 2 可以选择订购 TSP-9 结果。我们收集了 259 名执业胃肠病学家和胃肠外科医生的数据，他们对 3 种模拟 BE 患者类型进行了评估并做出了管理决策：非发育不良 BE、无限期发育不良和低度发育不良。结果 与对照相比，干预 1 明显更有可能正确评估进展为 HGD/EAC 的风险并根据美国学会指南提供治疗（+6.9%，95% CI +1.4% 至 +12.3%）。在订购指南推荐的内镜根除治疗方面没有显着差异。然而，对于需要每年进行内窥镜监测的病例，我们发现干预措施 1 的依从性显着改善，差异达 +18.5% (p=0.019)。干预 2 要求对 21.9% 的病例进行 TSP-9 测试。那些下令进行测试的人的表现与干预 1 类似；那些没有这样做的人，表现与对照组相似。讨论 TSP-9 测试优化了对疾病进展高风险和低风险 BE 患者监测和治疗的临床指南的遵守情况。使用 TSP-9 测试可以使医生做出符合风险的管理决策，从而改善患者的健康结果。