Esophagus to Small Intestine
Clin Gastroenterol Hepatol. 2022;20(4):e876–89
Prevalence and predictors of missed dysplasia on index Barrett’s esophagus diagnosing endoscopy in a veteran population
Background and aims: Limitations of endoscopic sampling may result in missed dysplasia at the diagnosis of Barrett’s esophagus (BE). However, the role of close follow-up endoscopy is unclear. The aim was to evaluate the proportion of patients diagnosed with “missed” dysplasia within 18 months of their index non-dysplastic BE (NDBE) diagnosis.
Methods: This was a retrospective analysis of a cohort of BE patients diagnosed during 1990–2019 at the Houston Veterans Affairs Medical Center. Patients with BE on index esophagogastroduodenoscopy (EGD) were classified as NDBE, indefinite dysplasia, or dysplastic (low- or high-grade dysplasia) based on initial biopsies. The authors identified NDBE patients who had follow-up EGD within 3–18 months after index EGD. They used logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for risk factors of dysplasia on follow-up EGD.
Results: 614 patients who had BE on index EGD were identified. Among those with NDBE and follow-up EGD within 3–18 months (n = 271), 4.1% had definite dysplasia on follow-up, and an additional 14.0% had indefinite dysplasia. Proportions of definite or indefinite dysplasia at follow-up within 3–18 months significantly decreased from 32.6% among patients with index EGD before 2009 to 11.7% among patients with index EGD after 2013 (ptrend = 0.068). Those with any indefinite or definite dysplastic BE at follow-up within 3–18 months after index EGD (n = 49) were more likely to have BE length ≥ 3 cm on index EGD (OR = 3.39; 95% CI: 1.63–7.08) than those with persistent NDBE or no BE on follow-up.
Conclusions: The occurrence of missed dysplasia on an index esophagogastroduodenoscopy has decreased over time. However, those with long-segment Barrett’s esophagus (BE) were > 3 times as likely to have missed dysplasia, and this group could benefit from dysplasia surveillance within 18 months of BE diagnosis.