Prevalence and Predictors of Barrett’s Esophagus After Negative Initial Endoscopy: Analysis From Two National Databases

医学 食管胃十二指肠镜检查 内科学 巴雷特食管 胃肠病学 人口 食管 回流 人口统计学的 逻辑回归 风险因素 内窥镜检查 疾病 腺癌 癌症 人口学 环境卫生 社会学
作者
Lovekirat Dhaliwal,Amrit K. Kamboj,J. Lucas Williams,Apoorva K. Chandar,Karan Sachdeva,Erin Gibbons,Ramona Lansing,Melissa Passe,Jaime A. Perez,Katelin Avenir,Scott A. Martin,Cadman L. Leggett,Amitabh Chak,Gary W. Falk,Sachin Wani,Nicholas J. Shaheen,John B. Kisiel,Prasad G. Iyer
出处
期刊:Clinical Gastroenterology and Hepatology [Elsevier BV]
卷期号:22 (3): 523-531.e3 被引量:1
标识
DOI:10.1016/j.cgh.2023.08.035
摘要

Background & Aims Guidelines suggest a single screening esophagogastroduodenoscopy (EGD) in patients with multiple risk factors for Barrett's esophagus (BE). We aimed to determine BE prevalence and predictors on repeat EGD after a negative initial EGD, using 2 large national databases (GI Quality Improvement Consortium [GIQuIC] and TriNetX). Methods Patients who underwent at least 2 EGDs were included and those with BE or esophageal adenocarcinoma detected at initial EGD were excluded. Patient demographics and prevalence of BE on repeat EGD were collected. Multivariate logistic regression was performed to assess for independent risk factors for BE detected on the repeat EGD. Results In 214,318 and 153,445 patients undergoing at least 2 EGDs over a median follow-up of 28–35 months, the prevalence of BE on repeat EGD was 1.7% in GIQuIC and 3.4% in TriNetX, respectively (26%–45% of baseline BE prevalence). Most (89%) patients had nondysplastic BE. The prevalence of BE remained stable over time (from 1 to >5 years from negative initial EGD) but increased with increasing number of risk factors. BE prevalence in a high-risk population (gastroesophageal reflux disease plus ≥1 risk factor for BE) was 3%–4%. Conclusions In this study of >350,000 patients, rates of BE on repeat EGD ranged from 1.7%–3.4%, and were higher in those with multiple risk factors. Most were likely missed at initial evaluation, underscoring the importance of a high-quality initial endoscopic examination. Although routine repeat endoscopic BE screening after a negative initial examination is not recommended, repeat screening may be considered in carefully selected patients with gastroesophageal reflux disease and ≥2 risk factors for BE, potentially using nonendoscopic tools. Guidelines suggest a single screening esophagogastroduodenoscopy (EGD) in patients with multiple risk factors for Barrett's esophagus (BE). We aimed to determine BE prevalence and predictors on repeat EGD after a negative initial EGD, using 2 large national databases (GI Quality Improvement Consortium [GIQuIC] and TriNetX). Patients who underwent at least 2 EGDs were included and those with BE or esophageal adenocarcinoma detected at initial EGD were excluded. Patient demographics and prevalence of BE on repeat EGD were collected. Multivariate logistic regression was performed to assess for independent risk factors for BE detected on the repeat EGD. In 214,318 and 153,445 patients undergoing at least 2 EGDs over a median follow-up of 28–35 months, the prevalence of BE on repeat EGD was 1.7% in GIQuIC and 3.4% in TriNetX, respectively (26%–45% of baseline BE prevalence). Most (89%) patients had nondysplastic BE. The prevalence of BE remained stable over time (from 1 to >5 years from negative initial EGD) but increased with increasing number of risk factors. BE prevalence in a high-risk population (gastroesophageal reflux disease plus ≥1 risk factor for BE) was 3%–4%. In this study of >350,000 patients, rates of BE on repeat EGD ranged from 1.7%–3.4%, and were higher in those with multiple risk factors. Most were likely missed at initial evaluation, underscoring the importance of a high-quality initial endoscopic examination. Although routine repeat endoscopic BE screening after a negative initial examination is not recommended, repeat screening may be considered in carefully selected patients with gastroesophageal reflux disease and ≥2 risk factors for BE, potentially using nonendoscopic tools.
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