High Rates of Dysplasia in a Population-Based Analysis of "Incidental" Barrett's Esophagus

Current screening and surveillance in Barrett's esophagus (BE) identifies only a minority of esophageal adenocarcinomas. Novel testing modalities may allow broadening of indications for BE screening. Whether such efforts are warranted depends on the characteristics of additional BE cases discovered, and their risk of progression. This study used national benchmarking data to characterize "incidental" BE.

Upper endoscopies with BE in GI Quality Improvement Consortium (GIQuIC) Registry from January 2015 to July 2022 were categorized by indication: BE screening, surveillance, or non-BE-related ("incidental"). Demographics, disease-specific characteristics, and dysplasia detection rate (DDR: low and high-grade dysplasia) were compared, as well as adherence to quality indicators.

Of 88,370 cases (67.3% male; 74.0% white) with histologically confirmed intestinal metaplasia, 88.1% were nondysplastic (NDBE). Most cases were performed for BE surveillance (65.0%). Incidental BE (16.4%) occurred almost as frequently as BE found in screening exams (18.6%). The mean BE segment length was longer in incidental BE (2.9 cm) than BE screening (2.6 cm) or surveillance (2.8 cm; P < .001). DDR was actually highest in incidental BE (3.8%), compared with surveillance or screening exams (2.5% and 3.3%; P < .0001). Adherence to appropriate surveillance was similar in incidental and screening (54.5% and 51.9%), with higher adherence in the surveillance group (73.6%; P < .0001).

BE is found incidentally at rates approaching those seen in dedicated screening exams. Incidental BE is not only common but has similar or worse high-risk features as BE in traditional screening and surveillance populations, given segment length and dysplasia yield. Refinement of BE screening programs could yield cases of similar risk of progression as traditional programs.