Age- and sex-specific yield of Barrett's esophagus by endoscopy indication

Abstract

Background: Barrett's esophagus is a precursor of esophageal adenocarcinoma, both of which are associated with GERD. Screening GERD patients for Barrett's esophagus has been suggested, but it is not known which patients should be screened and at what age.

Objective: To determine the age-specific yield of endoscopy for Barrett's esophagus stratified by sex and indication for endoscopy.

Design: Retrospective cross-sectional study.

Setting: National Endoscopic Database of the Clinical Outcomes Research Initiative (CORI).

Patients: A total of 155,641 patients undergoing their first endoscopy at one of the CORI sites for clinical indications.

Main outcome measurements: Age-specific yield of Barrett's esophagus.

Results: Among white men with GERD, the yield of Barrett's esophagus increases steeply from early adulthood (2.1% in the third decade of life) to middle adulthood (9.3% in the sixth decade) and then plateaus (the difference for the eighth decade minus the sixth decade is -1.1%; 95% CI, -3.9% to 1.7%). There is no difference in the yield of Barrett's esophagus between middle-aged white women with GERD and white men without GERD (difference is -0.46%; 95% CI, -1.23% to 0.31%).

Limitations: Possible bias by selection for endoscopy and the potential for misclassification of GERD status.

Conclusions: The yield of upper endoscopy for the diagnosis of Barrett's esophagus increases rapidly among white men with GERD until approximately age 50 and then reaches a plateau. White women with GERD are at no increased risk compared with white men without GERD.

Figure 1. Yield of Upper Endoscopy for Histologically Confirmed Barrett’s Esophagus

The x-axis represents age at time of endoscopy. Patients were categorized by decade of age, and the proportion of endoscopies with histologically confirmed Barrett’s esophagus for each decade is shown at the midpoint of that age category. Each line represents the yield for each gender with and without an indication of evaluation of GERD or screening for Barrett’s esophagus (“GERD Screenees” or “without GERD”). Data were obtained from sub-cohort with pathology reports available.

Figure 2. Age-Specific Trend in Yield of Endoscopically Suspected Barrett’s Esophagus Among White Male GERD Screenees

The x-axis represents the year of the endoscopy, and each line represents the time trend in the proportion of endoscopies with findings consistent with Barrett’s esophagus for each age group. This figure only shows results for white men with an indication of evaluation of GERD or screening for Barrett’s esophagus. No trend was detected in other groups. Data were obtained from the total cohort.

Figure 3. Trend in Length of Suspected Barrett’s Esophagus

Each stacked column represents the sum of endoscopies with suspected Barrett’s esophagus for each year. The proportion of suspected Barrett’s esophagus that was at least 3 cm in length (long segment) decreased during the time frame, while the proportion of short segment (< 3 cm) increased. Data were obtained from the total cohort.