Neoplasia Detection Rate in Barrett’s Esophagus: A Measure of High-Quality Upper Endoscopy

Studies have reported that up to 25% of esophageal adenocarcinomas (EACs) are detected within 1 year of index endoscopy (missed cancer), emphasizing the need for high-quality endoscopy in patients with Barrett’s esophagus (BE). Recent studies have proposed the use of the neoplasia detection rate ([NDR] the percentage of patients with BE who have high-grade dysplasia [HGD] or EAC on screening endoscopy) as a quality measure akin to the adenoma detection rate used in colonoscopies. The aim of this population-based cohort study was to estimate NDR and its effect on missed dysplasia. 

In this study of 1066  patients, (72% male; mean age, 63 years; mean BE length, 3.6 cm), the authors reported an NDR of 4.9% (3.1% with HGD and 1.8% with EAC). Higher rates of NDR were associated with male gender, older age, BE length, smoking history, and endoscopy conducted by gastroenterologists. Of note, gastroenterologists had a substantially higher rate of neoplasia detection than nongastroenterologists (5.8% vs 1.7%; P=.0098). Furthermore, significantly more visible lesions within the BE segment were reported by gastroenterologists compared to nongastroenterologists (odds ratio [OR], 3.7; P=.0120). The estimated missed dysplasia (dysplasia detected within 1 year of index endoscopy) in this cohort was 13% (lower than previous reports). There was no significant difference between patients with and without missed dysplasia with regard to length of BE (P=.4), adherence to the Seattle protocol (P=.8), visible lesion (OR, 0.6; 95% confidence interval, 0.11-3.25), age, smoking history, or endoscopist specialty.