Am J Gastroenterol. 2023 Jan 30. doi: 10.14309/ajg.0000000000002204. Online ahead of print.
ABSTRACT
OBJECTIVE: Guidelines suggest one time screening with esophagogastroduodenoscopy (EGD) for Barrett’s esophagus (BE) in individuals at increased risk for esophageal adenocarcinoma (EAC). We aimed to estimate the yield of repeat EGD performed at prolonged intervals following a normal index EGD.
DESIGN: We conducted a national retrospective analysis within the United States Veterans Health Administration, identifying patients with a normal index EGD between 2003 and 2009 who subsequently had a repeat EGD. We tabulated the proportion with a new diagnosis of BE, EAC or esophagogastric junction adenocarcinoma (EGJAC), and conducted manual chart review of a sample. We fitted logistic regression models for the odds of a new diagnosis of BE/EAC/EGJAC.
RESULTS: We identified 71,216 individuals who had a repeat EGD between 1 and 16 years following an index EGD without billing or cancer registry codes for BE/EAC/EGJAC. Of those, 4,088 had a new billing or cancer registry code for BE/EAC/EGJAC following the repeat EGD. On manual review of a stratified sample, most did not truly have new BE/EAC/EGJAC. Longer duration between EGDs was associated with greater odds of a new diagnosis (adjusted odds ratio [aOR] for each 5 years = 1.31; 95% confidence interval [CI] = 1.19, 1.44), particularly among those who were younger at the time of the index EGD (ages 19-29: aOR = 3.92; 95% CI = 1.24, 12.4; ages 60-69: aOR = 1.19; 95% CI = 1.01, 1.40).
CONCLUSION: The yield of repeat EGD for BE/EAC/EGJAC appears to increase with time following a normal index EGD, particularly for younger individuals. Prospective studies are warranted to confirm these findings.
PMID:36716445 | DOI:10.14309/ajg.0000000000002204
