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. 2024 Mar;22(3):523-531.e3.
doi: 10.1016/j.cgh.2023.08.035. Epub 2023 Sep 15.

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

Lovekirat Dhaliwal  1 , Amrit K Kamboj  2 , J Lucas Williams  3 , Apoorva K Chandar  4 , Karan Sachdeva  1 , Erin Gibbons  2 , Ramona Lansing  2 , Melissa Passe  2 , Jaime A Perez  5 , Katelin L R Avenir  5 , Scott A Martin  5 , Cadman L Leggett  2 , Amitabh Chak  6 , Gary W Falk  7 , Sachin Wani  8 , Nicholas J Shaheen  9 , John B Kisiel  2 , Prasad G Iyer  10
Affiliations

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

Lovekirat Dhaliwal et al. Clin Gastroenterol Hepatol. 2024 Mar.

Abstract

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.

Keywords: Endoscopy; Esophageal adenocarcinoma; Screening.

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Figures

Figure 1:
Figure 1:
The prevalence of BE by time interval after negative initial EGD for BE in GIQuIC and TriNetX.
Figure 2:
Figure 2:
The prevalence of BE based on the number of risk factors present stratified by GERD status.
See this image and copyright information in PMC

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