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- Title
Yield of Repeat Endoscopy in Barrett's Esophagus with No Dysplasia and Low-Grade Dysplasia: A Population-Based Study.
- Authors
Visrodia, Kavel; Iyer, Prasad; Schleck, Cathy; Zinsmeister, Alan; Katzka, David; Iyer, Prasad G; Schleck, Cathy D; Zinsmeister, Alan R; Katzka, David A
- Abstract
<bold>Background: </bold>The yield of early repeat endoscopy in patients with Barrett's esophagus (BE) is not well established.<bold>Aims: </bold>To determine how often early repeat endoscopy detected missed dysplasia or esophageal adenocarcinoma (EAC) in a population-based cohort of patients with BE. Secondary aims were to identify risk factors for missed dysplasia/EAC and compare detection of prevalent versus incident HGD/EAC.<bold>Methods: </bold>A population-based cohort of BE subjects in Olmsted County, MN, was studied. Patients with initial non-dysplastic BE or low-grade dysplasia (LGD) who underwent repeat endoscopy within 24 months were included. Those with a worse histologic diagnosis on repeat endoscopy were considered to have missed dysplasia/EAC. Baseline characteristics among patients with and without missed dysplasia/EAC were compared. The absolute numbers of asymptomatic prevalent or missed, and incident HGD/EAC in the entire cohort were ascertained.<bold>Results: </bold>Of 488 BE cases, 210 were included for the primary aim of this study. Repeat endoscopy revealed four HGD/EAC (1.9 %) and 16 LGD (8.8 %) for a combined miss rate of 9.5 %. Long-segment BE (LSBE) and lack of PPI use were predictors of missed dysplasia/EAC (P = 0.008), but adherence to biopsy protocol was not. Increased prevalent HGD/EAC (n = 30) rather than incident HGD/EAC (n = 22) was identified during a median 4.8 years of follow-up in this cohort.<bold>Conclusions: </bold>Dysplasia/EAC is commonly missed at initial BE diagnosis, particularly in patients with LSBE and no PPI use. Efforts should be made to enhance the sensitivity of detecting dysplasia/neoplasia around the time of initial BE diagnosis.
- Subjects
MINNESOTA; BARRETT'S esophagus; DYSPLASIA; ENDOSCOPY; MEDICAL statistics; MEDICAL protocols; PATIENTS; ADENOCARCINOMA; BIOPSY; DIAGNOSTIC errors; ESOPHAGEAL tumors; PRECANCEROUS conditions; RESEARCH funding; TIME; PREDICTIVE tests; DISEASE incidence; DISEASE prevalence; RETROSPECTIVE studies; ENDOSCOPIC gastrointestinal surgery; EARLY detection of cancer; TUMOR grading
- Publication
Digestive Diseases & Sciences, 2016, Vol 61, Issue 1, p158
- ISSN
0163-2116
- Publication type
journal article
- DOI
10.1007/s10620-015-3697-6