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

Area of Science:

• Gastroenterology
• Endoscopy
• Oncology

Background:

• Current guidelines recommend a single screening esophagogastroduodenoscopy (EGD) for individuals with multiple risk factors for Barrett's esophagus (BE).
• The prevalence and predictors of BE on repeat EGD after a negative initial examination require further investigation.

Purpose of the Study:

• To determine the prevalence of BE on repeat EGD after a negative initial EGD.
• To identify predictors of BE detected on repeat EGD.
• To evaluate the utility of repeat EGD screening for BE.

Main Methods:

• Analysis of two large national databases (GIQuIC and TriNetX) including over 350,000 patients who underwent at least two EGDs.
• Exclusion of patients with BE or esophageal adenocarcinoma detected at their initial EGD.
• Multivariate logistic regression to identify independent risk factors for BE on repeat EGD.

Main Results:

• BE prevalence on repeat EGD was 1.7% in GIQuIC and 3.4% in TriNetX, representing 26%-45% of baseline prevalence.
• Most detected BE cases (89%) were nondysplastic.
• BE prevalence increased with the number of risk factors and was 3%-4% in high-risk populations (GERD + ≥1 risk factor).

Conclusions:

• Repeat EGD identified BE in 1.7%-3.4% of patients, with higher rates in those with multiple risk factors, suggesting potential missed diagnoses during initial screening.
• Routine repeat endoscopic BE screening is not recommended, but may be considered for carefully selected patients with GERD and multiple risk factors, potentially aided by non-endoscopic tools.