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.

G.A. Ketwaroo, M.D., Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA,
E-Mail: gyanprakash.ketwaroo@bcm.edu

DOI: DOI: 10.1016/j.cgh.2021.04.008

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