Over-Utilization of Repeat Upper Endoscopy in Patients with Non-dysplastic Barrett's Esophagus: A Quality Registry Study

Am J Gastroenterol. 2019 Aug;114(8):1256-1264. doi: 10.14309/ajg.0000000000000184.

Abstract

Introduction: Guidelines recommend that patients with non-dysplastic Barrett's esophagus (NDBE) undergo surveillance endoscopy every 3-5 years. Using a national registry, we assessed compliance to recommended surveillance intervals in patients with NDBE and identified factors associated with compliance.

Methods: We analyzed data from the GI Quality Improvement Consortium registry. Data abstracted include procedure indication, demographics, endoscopy/pathology results, and recommendations for future endoscopy. Patients with an indication of Barrett's esophagus (BE) screening or surveillance, or an endoscopic finding of BE, with non-dysplastic intestinal metaplasia on pathological examination, were included. Compliance was defined as a recommendation to undergo subsequent endoscopy between 3 and 5 years. Multivariate logistic regression was conducted to assess variables associated with compliance.

Results: Of 786,712 endoscopies assessed, 58,709 (7.5%) endoscopies in 53,541 patients met inclusion criteria (mean age 61.3 years, 60.4% men, 90.2% white, mean BE length was 2.3 cm). Most cases were performed by Gastroenterologists (92.3%) with propofol (78.7%). A total of 29,978 procedures (55.8%) resulted in pathology-confirmed BE. Among procedures with NDBE (n = 25,945), 29.9% were noncompliant with the 3-year threshold; most (26.9%) recommended surveillance at 1- to 2-year intervals. Patient factors such as extremes of age, black race, geographic region, type of sedation, and increasing BE length were associated with noncompliance.

Discussion: Approximately 30% of patients with NDBE are recommended to undergo surveillance endoscopy too soon. Patient factors associated with inappropriate utilization include extremes of age, black race, and increasing BE length. Compliance with appropriate endoscopic follow-up as a quality measure in BE is poor.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aftercare
  • Aged
  • Barrett Esophagus / diagnosis*
  • Barrett Esophagus / pathology
  • Endoscopy, Digestive System / statistics & numerical data*
  • Female
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Male
  • Medical Overuse / statistics & numerical data*
  • Middle Aged
  • Practice Guidelines as Topic
  • Registries
  • Retrospective Studies
  • Watchful Waiting / standards*