Management of Barrett's Esophagus in the UK: Overtreated and Underbiopsied but Improved by the Introduction of a National Randomized Trial
The American Journal of GastroenterologyPublished 28 April 2008
Debasish Das, Savid Ishaq, Rebecca Harrison, Kiran Kosuri, Edward Harper, John de Caestecker
Citations98
SJR quartileQ1
SJR score2.34
SNIP2.27
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TL;DR
The improvement in practice in centers taking part in the AspECT trial indicates an additional value of large international RCTs, and wide variation in practice and poor compliance with guidelines are indicated.
Abstract
This large study indicates both wide variation in practice and poor compliance with guidelines. Because optimal histology is arguably the most important facet of BE management, the improvement in practice in centers taking part in the AspECT trial indicates an additional value of large international RCTs.
Keywords
Medicine
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