Use of Appropriate Surveillance for Patients With Nondysplastic Barrett's Esophagus

Anna Tavakkoli, Henry D. Appelman, David G. Beer, Chaitra Madiyal, Maryam Khodadost, Kimberly Nofz, Val Metko, Grace Elta, Thomas Wang, Joel H. Rubenstein

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background & Aims: Barrett's esophagus (BE) is a precursor to esophageal adenocarcinoma (EAC). Guidelines recommend that patients with nondysplastic BE (NDBE) undergo surveillance endoscopy every 3–5 years. We aimed to identify factors associated with surveillance endoscopy of patients with NDBE and identify trends in appropriate surveillance endoscopy of NDBE at a large tertiary care center. Methods: We performed a retrospective analysis of data from a Barrett's Esophagus Registry, identifying patients with NDBE who underwent endoscopy in 2002 or later. We identified patients with NDBE and collected data on length of BE segment, esophageal lesions, demographic features, medications, histology findings, comorbidities, development of EAC, and dates of follow-up endoscopies. We defined appropriate surveillance as 3–5 years between 2nd and 3rd endoscopies, over-utilizers as patients who had less than 3 years between their 2nd and 3rd endoscopies, under-utilizers as patients who had more than 5 years between their 2nd and 3rd endoscopies; and never-surveilled as patients who never received a 2nd endoscopy. The primary outcomes were effects of patient factors, year, and referring providers on appropriateness of surveillance intervals. Results: We identified 477 patients with NDBE. Only 15.9% had appropriate surveillance; 37.9% were over-utilizers 15.7% were under-utilizers and 30.4% were never surveilled. Patients were less likely to be over-surveilled if their primary care physician referred them for their 3rd endoscopy instead of a gastroenterologist (adjusted odds ratio, 0.51; 95% CI, 0.27–0.95). Male patients or those with an increased number of comorbidities were more likely to be under-surveilled or never-surveilled, whereas patients with long BE segment were more likely to be over-surveilled. Conclusions: In a retrospective analysis of data from a registry of patients with BE, we found that less than 16% receive appropriate surveillance for NDBE. A primary care provider in the same health system as the endoscopy clinic reduced risk of over-surveillance. This could reflect better coordination of care between specialists and primary care providers.

Original languageEnglish (US)
Pages (from-to)862-869.e3
JournalClinical Gastroenterology and Hepatology
Volume16
Issue number6
DOIs
StatePublished - Jun 2018
Externally publishedYes

Fingerprint

Barrett Esophagus
Endoscopy
Registries
Comorbidity
Primary Health Care
Adenocarcinoma
Primary Care Physicians
Tertiary Care Centers
Histology

Keywords

  • Cancer Risk
  • Early Detection
  • PCP
  • Prevention

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Tavakkoli, A., Appelman, H. D., Beer, D. G., Madiyal, C., Khodadost, M., Nofz, K., ... Rubenstein, J. H. (2018). Use of Appropriate Surveillance for Patients With Nondysplastic Barrett's Esophagus. Clinical Gastroenterology and Hepatology, 16(6), 862-869.e3. https://doi.org/10.1016/j.cgh.2018.01.052

Use of Appropriate Surveillance for Patients With Nondysplastic Barrett's Esophagus. / Tavakkoli, Anna; Appelman, Henry D.; Beer, David G.; Madiyal, Chaitra; Khodadost, Maryam; Nofz, Kimberly; Metko, Val; Elta, Grace; Wang, Thomas; Rubenstein, Joel H.

In: Clinical Gastroenterology and Hepatology, Vol. 16, No. 6, 06.2018, p. 862-869.e3.

Research output: Contribution to journalArticle

Tavakkoli, A, Appelman, HD, Beer, DG, Madiyal, C, Khodadost, M, Nofz, K, Metko, V, Elta, G, Wang, T & Rubenstein, JH 2018, 'Use of Appropriate Surveillance for Patients With Nondysplastic Barrett's Esophagus', Clinical Gastroenterology and Hepatology, vol. 16, no. 6, pp. 862-869.e3. https://doi.org/10.1016/j.cgh.2018.01.052
Tavakkoli, Anna ; Appelman, Henry D. ; Beer, David G. ; Madiyal, Chaitra ; Khodadost, Maryam ; Nofz, Kimberly ; Metko, Val ; Elta, Grace ; Wang, Thomas ; Rubenstein, Joel H. / Use of Appropriate Surveillance for Patients With Nondysplastic Barrett's Esophagus. In: Clinical Gastroenterology and Hepatology. 2018 ; Vol. 16, No. 6. pp. 862-869.e3.
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abstract = "Background & Aims: Barrett's esophagus (BE) is a precursor to esophageal adenocarcinoma (EAC). Guidelines recommend that patients with nondysplastic BE (NDBE) undergo surveillance endoscopy every 3–5 years. We aimed to identify factors associated with surveillance endoscopy of patients with NDBE and identify trends in appropriate surveillance endoscopy of NDBE at a large tertiary care center. Methods: We performed a retrospective analysis of data from a Barrett's Esophagus Registry, identifying patients with NDBE who underwent endoscopy in 2002 or later. We identified patients with NDBE and collected data on length of BE segment, esophageal lesions, demographic features, medications, histology findings, comorbidities, development of EAC, and dates of follow-up endoscopies. We defined appropriate surveillance as 3–5 years between 2nd and 3rd endoscopies, over-utilizers as patients who had less than 3 years between their 2nd and 3rd endoscopies, under-utilizers as patients who had more than 5 years between their 2nd and 3rd endoscopies; and never-surveilled as patients who never received a 2nd endoscopy. The primary outcomes were effects of patient factors, year, and referring providers on appropriateness of surveillance intervals. Results: We identified 477 patients with NDBE. Only 15.9{\%} had appropriate surveillance; 37.9{\%} were over-utilizers 15.7{\%} were under-utilizers and 30.4{\%} were never surveilled. Patients were less likely to be over-surveilled if their primary care physician referred them for their 3rd endoscopy instead of a gastroenterologist (adjusted odds ratio, 0.51; 95{\%} CI, 0.27–0.95). Male patients or those with an increased number of comorbidities were more likely to be under-surveilled or never-surveilled, whereas patients with long BE segment were more likely to be over-surveilled. Conclusions: In a retrospective analysis of data from a registry of patients with BE, we found that less than 16{\%} receive appropriate surveillance for NDBE. A primary care provider in the same health system as the endoscopy clinic reduced risk of over-surveillance. This could reflect better coordination of care between specialists and primary care providers.",
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AU - Khodadost, Maryam

AU - Nofz, Kimberly

AU - Metko, Val

AU - Elta, Grace

AU - Wang, Thomas

AU - Rubenstein, Joel H.

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