Majority of At-Risk Patients Not Screened for Barrett’s Esophagus
Prateek Sharma, MD, FASGE, reviewing Stewart M, et al. Gastroint Endosc 2023 Mar 12.
The current screening model for Barrett’s esophagus (BE) has limitations because patients need to be identified by their primary care physician and then referred to gastroenterology for endoscopic screening. Screening is further complicated because not everyone needs to be screened unless they have specific risk factors. Guidelines from the American Society for Gastrointestinal Endoscopy and American College of Gastroenterology, as well as the Kunzmann model, can be used to identify high-risk patients through electronic medical records, which can help primary care physicians identify patients eligible for screening. This study aimed to determine how many eligible patients were being screened for BE in a large health system’s primary care setting.
Out of 936,371 primary care charts examined by the algorithm, 3535 patients (0.4%) were identified as being at high risk for BE. However, of those patients, only 1077 (30%) were actually screened for BE with endoscopy in a clinical setting. The additional 2458 (70%) patients identified by the algorithm as being at high risk for BE had not been screened. Among the patients who underwent clinical screening, only 105 (10%) were diagnosed with BE, and 10% of those cases involved neoplasia.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Stewart M, Menon A, Akbar U, Garg S, Jang HJ, Trindade AJ. Missed opportunities for screening for Barrett’s esophagus in the primary care setting of a large health system. Gastrointest Endosc 2023 Mar 12. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2023.03.010)