Overutilization of endoscopic surveillance in nondysplastic Barrett's esophagus: a multicenter study

Gastrointest Endosc. 2012 Jan;75(1):23-31.e2. doi: 10.1016/j.gie.2011.08.042. Epub 2011 Nov 17.


Background: Guidelines suggest that patients with nondysplastic Barrett's esophagus (BE) undergo endoscopic surveillance every 3 to 5 years, but actual use of surveillance endoscopy and the determinants of variation in surveillance intervals are not known.

Objective: To measure use of surveillance endoscopy and its variation in patients with nondysplastic BE.

Design: Multicenter, cross-sectional study.

Setting: Three sites in Arizona, Minnesota, and North Carolina.

Patients: This study involved patients who had prevalent BE without a history of high-grade dysplasia or esophageal adenocarcinoma.

Intervention: Participants were given validated measures of quality of life, numeracy, and cancer risk perception, and the total number of prior endoscopic surveillance examinations was measured.

Main outcome measurements: Oversurveillance was defined as >1 surveillance examination per 3-year period.

Results: Among 235 patients with nondysplastic BE, 76% were male and 94% were white. The average (± standard deviation [SD]) duration of BE was 6.5 ± 5.9 years. The mean (± SD) number of endoscopies per 3-year period was 2.7 ± 2.6. Oversurveillance was present in 65% of participants, resulting in a mean of 2.3 excess endoscopies per patient. Neither numeracy skills nor patient perception of cancer risk were associated with oversurveillance.

Limitations: Endoscopies were measured by patient report, which is subject to error. Results may be generalizable only to patients seen in academic centers.

Conclusion: Most patients with nondysplastic BE had more surveillance endoscopic examinations than is recommended by published guidelines. Patient factors did not predict oversurveillance, indicating that other factors may influence decisions about the interval and frequency of surveillance examinations.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adenocarcinoma / diagnosis*
  • Adenocarcinoma / pathology
  • Aged
  • Aged, 80 and over
  • Barrett Esophagus / pathology*
  • Barrett Esophagus / psychology
  • Chi-Square Distribution
  • Cross-Sectional Studies
  • Esophageal Neoplasms / diagnosis*
  • Esophageal Neoplasms / pathology
  • Esophagoscopy / statistics & numerical data*
  • Female
  • Guideline Adherence
  • Heartburn
  • Humans
  • Insurance, Health
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Patient Acceptance of Health Care / psychology
  • Perception
  • Practice Guidelines as Topic
  • Precancerous Conditions / pathology*
  • Precancerous Conditions / psychology
  • Quality of Life
  • Sentinel Surveillance
  • Severity of Illness Index
  • Time Factors
  • Unnecessary Procedures / statistics & numerical data*