E0205 - Risk of Barrett's Esophagus After a Negative Index Endoscopy: An Analysis Using the GIQUIC National Benchmarking Registry

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

LD

Lovekirat Dhaliwal, MD

Oschner LSU Health Shreveport
Shreveport, LA

Lovekirat Dhaliwal, MD¹, Amrit K. Kamboj, MD², Karan Sachdeva, MBBS², Erin Gibbons, BS², Ramona Lansing, BSN², Melissa Passe, BSN², Cadman Leggett, MD², John Kisiel, MD², Prasad G. Iyer, MD, FACG²
¹Oschner LSU Health Shreveport, Shreveport, LA; ²Mayo Clinic, Rochester, MN

Introduction: Current guidelines recommend single screening endoscopy in patients with multiple risk factors for Barrett’s esophagus (BE). Data suggesting a low risk of BE after a negative esophagogastroduodenoscopy (EGD) are limited by small sample size and short follow-up after initial EGD. There remains a possibility of missed or incident BE after a negative index EGD. With the advent of cost-effective, non-endoscopic BE screening tools, repeat screening may be a consideration in high-risk patients. We aimed to determine the prevalence and predictors of BE after a negative index evaluation, on repeat EGD in a large national endoscopic database.

Methods: We analyzed data from the GI Quality Improvement Consortium Registry (GIQuIC), a large nationwide quality benchmarking clinical registry, from 2013-2020. We included patients who underwent at least 2 EGDs. Patients diagnosed with or with a history of BE or esophageal adenocarcinoma (EAC) at index EGD were excluded. Data on prevalence of BE/EAC on second/subsequent EGDs, and known risk factors for BE were collected. Univariate and multivariate logistic regression analyses were performed to assess association between predictors and outcome of BE/EAC on repeat EGD.

Results: The prevalence of BE at index endoscopy in the GIQuIC database is 4.2%. A total of 124,223 patients underwent at least 1 EGD (mean number of repeat EGDs 1.39, range 1-63). Of these, 2,272 (1.83%, 95% CI 1.75, 1.90%) were found to have BE/EAC. Table 1 shows the prevalence of BE/EAC stratified by risk factors. Risk factors associated with BE/EAC on repeat endoscopy included GERD (OR: 3.36, p < 0.01), male sex (OR: 1.85, p< 0.01), White race (OR: 1.76, p< 0.01), age 50-80 years (OR: 1.53, p< 0.01), and obesity (OR: 1.20, p=0.04). In patients with GERD and an additional risk factor, the prevalence of BE/EAC was higher at 3.4% at a mean (SD) time interval of 13.1 (14.1) months after a negative index EGD. The prevalence of BE/EAC increased with increasing number of risk factors (Figure 1).

Discussion: The prevalence of BE/EAC after an initial negative index EGD was approximately 2% (44% of baseline BE prevalence in GIQuIC), with most cases diagnosed within 5 years. In patients with two or more risk factors, the prevalence was two fold higher. Repeat evaluation for BE, particularly with non-endoscopic techniques, may be considered in patients with multiple risk factors, 1-5 years after initial negative evaluation.

Figure: The distribution of BE/EAC diagnosed after initial negative endoscopy stratified by the number of risk factors present per patient and GERD.

Characteristic	No BE/EAC (N = 121,951, 98.17%)	BE/EAC (N = 2,272, 1.83%)	p-value
Age (years)			< 0.0001
< 50	27,466 (22.8%)	411 (18.1%)
50-80	85,262 (69.9%)	1,762 (77.6%)
>80	8,890 (7.3%)	99 (4.4%)
Male sex	48,224 (39.5%)	1,247 (54.9%)	< 0.0001
White race	82,8384 (82.8%)	1,663 (90.0%)	< 0.0001
GERD*	39,035 (32.0%)	1,346 (59.2%)	< 0.0001
Obesity (BMI >30)	6,600 (35.5%)	217 (40.3%)	0.0204
Time interval between EGDs			< 0.0001
< 1year	69,485 (57.0%)	1,475 (64.9%)
1 to < 3 years	41,828 (34.3%)	617 (27.2%)
3 to < 5 years	10,134 (8.3%)	174 (7.7%)
>=5 years	504 (0.4%)	6 (0.3%)
Indication for second EGD
Screening for BE	1,218 (1.0%)	130 (5.7%)	< 0.0001
Reflux	39,035 (32.0%)	1,346 (59.2%)	< 0.0001
Ulcer	15,071 (12.4%0	264 (11.6%)	0.2890
Weight loss	2,493 (2.0%0	19 (0.8%)	< 0.0001
Dysphagia	41,391 (33.9%)	547 (24.1%)	< 0.0001
Esophagitis	11,607 (9.5%)	570 (25.1%)	< 0.0001
GI bleeding/anemia	25,296 (20.7%)	227 (10.0%)	< 0.0001
Vomiting	6,657 (5.5%)	84 (3.7%)	0.0002
Other	12,346 (10.1%)	185 (8.1%)	0.0019
*Based on indication of 2nd EGD

Table: Baseline characteristics of patients with and without BE/EAC on follow-up EGD after negative index EGD

Disclosures:

Lovekirat Dhaliwal indicated no relevant financial relationships.

Amrit Kamboj indicated no relevant financial relationships.

Karan Sachdeva indicated no relevant financial relationships.

Erin Gibbons indicated no relevant financial relationships.

Ramona Lansing indicated no relevant financial relationships.

Melissa Passe indicated no relevant financial relationships.

Cadman Leggett indicated no relevant financial relationships.

Cadman Leggett — NO DISCLOSURE DATA.

John Kisiel: Exact Sciences – Consultant, Grant/Research Support, Intellectual Property/Patents, Royalties.

Prasad Iyer: CDX Medical – Consultant, Grant/Research Support. Cernostics – Consultant, Grant/Research Support. Exact Sciences – Consultant, Grant/Research Support, Intellectual Property/Patents. Medtronic – Consultant. Pentax Medical – Consultant, Grant/Research Support.

Lovekirat Dhaliwal, MD¹, Amrit K. Kamboj, MD², Karan Sachdeva, MBBS², Erin Gibbons, BS², Ramona Lansing, BSN², Melissa Passe, BSN², Cadman Leggett, MD², John Kisiel, MD², Prasad G. Iyer, MD, FACG². E0205 - Risk of Barrett's Esophagus After a Negative Index Endoscopy: An Analysis Using the GIQUIC National Benchmarking Registry, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.