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ABSTRACT
Background and Aims
The rate of esophageal adenocarcinoma (EAC) is rising. This is partly due to the lack
of identification of Barrett's esophagus (BE), the main risk factor for EAC. Identifying
neoplastic BE can allow for endoscopic therapy to prevent EAC. Our aim was to determine
how many eligible patients for screening are being screened for BE in the primary
care setting of a large health system.
Methods
A digital search algorithm was constructed using the established gastroenterology
guidelines and Kunzmann model for screening for BE. The algorithm was then applied
to the electronic medical record of all patients seen in the primary care setting
of the health system. A manual review of charts of the identified patients was performed
to confirm the high-risk status and determine if screening occurred.
Results
Of 936,371 primary care charts analyzed by the algorithm, 3535 patients (0.4%) were
determined to be high-risk for BE. Of the 3535 patients, only 1077 (30%) were screened
for BE in clinical practice with endoscopy. The algorithm identified 2,458 (70%) additional
high-risk patients. Of the patients screened in clinical practice, 105 (10%) were
found to have BE (10% with neoplasia).
Conclusion
Numerous screening opportunities for Barrett's esophagus are missed in the primary
care setting of a large health system. Collaboration between gastroenterology and
primary care services is needed to improve the screening rate.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
Barrett’s esophagus (BE), esophageal adenocarcinoma (EAC), Gastrointestinal reflux (GERD), American College of Gastroenterology (ACG), American Society of Gastrointestinal Endoscopy (ASGE), electronic medical record (EMR)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
March 7,
2023
Received in revised form:
February 25,
2023
Received:
December 17,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
GRANT /FUNDING SUPPORT:
None
Guarantor of the article: Arvind Trindade
CONFLICT OF INTEREST DISCLOSURE:
AJT is a consultant for Pentax Medical, Boston Scientific, Lucid Diagnostic, and Exact Science. AJT receives research support from Lucid Diagnostics.
MS, AM, UA, and SG, and HJ have no conflicts of interests to disclose
All authors approved the final version of the manuscript.
Author Contributions:
Conception and design (AJT)
Analysis and interpretation of the data (AJT, MS, AM, UA, SG, HJ)
Drafting of the article (AJT, SG, UA, AM)
Critical revision of the article for important intellectual content (AJT, MS, AM, UA, SG, HJ)
Final approval of the article (AJT, MS, AM, UA, SG, HJ)
Identification
Copyright
© 2023 by the American Society for Gastrointestinal Endoscopy
