Background & Aims

Guidelines suggest endoscopic screening of individuals who are at increased risk for Barrett’s esophagus (BE) and esophageal adenocarcinoma. Tools based on clinical factors are available for identifying patients at risk, but only some have been validated. We aimed to compare and validate available tools.

Methods

We performed a prospective study of 1241 patients, ages 40 to 79 years, presenting either for their first esophagogastroduodenoscopy (EGD) or their first endoscopic therapy of early neoplastic BE, from April 2015 through June 2018. We calculated risk scores for 6 previously published tools (the Gerson, Locke, Thrift, Michigan BE pREdiction Tool [M-BERET], Nord-Trøndelag Health Study [HUNT], and Kunzmann tools). We also investigated the accuracy of frequency and duration of gastroesophageal reflux disease (GERD), using data from a randomly selected 50% of patients undergoing their first EGD. We compared the ability of all these tools to discriminate patients with BE and early neoplasia from patients without BE, using findings from endoscopy as the reference standard.

Results

BE was detected in 81 of 1152 patients during their first EGD (7.0%). GERD symptoms alone identified patients with BE with an area under the receiver operating characteristic curve (AuROC) of 0.579. All of the tools were more accurate in identifying patients with BE than the frequency and duration of GERD (AuROC for GERD, 0.579 vs range for other tools, 0.660–0.695), and predicted risk correlated well with observed risk (calibration). The AUROCs of the HUNT tool (0.796), the M-BERET (0.773), and the Kunzmann tool (0.763) were comparable in discriminating between patients with early neoplasia (n = 94) vs no BE. Each tool was more accurate in discriminating BE with early neoplasia than GERD frequency and duration alone (AuROC, 0.667; P < .01).

Conclusions

The HUNT, M-BERET, and Kunzmann tools identify patients with BE with AuROC values ranging from 0.665 to 0.695, and discriminate patients with early neoplasia from patients without BE with AuROC values ranging from 0.763 to 0.796. These tools are more accurate than frequency and duration of GERD in identifying individuals at risk for neoplastic BE.

中文翻译：

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验证和比较用于筛选Barrett食管和早期肿瘤的个体的工具。

背景与目标

指南建议对有Barrett食道（BE）和食道腺癌风险较高的个体进行内窥镜检查。可使用基于临床因素的工具来识别有风险的患者，但只有一些经过了验证。我们旨在比较和验证可用工具。

方法

我们对2015年4月至2018年6月进行的首次食管胃十二指肠镜检查（EGD）或首次内镜治疗早期肿瘤性BE的1241例患者进行了一项前瞻性研究。我们计算了6种先前发表的工具的风险评分（Gerson，Locke，Thrift和Michigan的预测工具[M-BERET]，Nord-Trøndelag健康研究[HUNT]和Kunzmann工具）。我们还使用随机选择的50％进行首次EGD的患者的数据调查了胃食管反流疾病（GERD）的频率和持续时间的准确性。我们使用内窥镜检查的结果作为参考标准，比较了所有这些工具将BE患者和早期瘤形成与BE患者区别开来的能力。

结果

在1152例患者的首次EGD期间（81％）检测到BE（7.0％）。仅使用GERD症状就可以识别出BE患者的接收器工作特征曲线（AuROC）为0.579。与GERD的频率和持续时间（GERD的AuROC，0.579 vs其他工具的范围，0.660-0.695）相比，所有工具在识别BE患者方面均更为准确，并且预测的风险与观察到的风险（校准）具有很好的相关性。HUNT工具（0.796），M-BERET（0.773）和Kunzmann工具（0.763）的AUROC在区分早期肿瘤（n = 94）与无BE的患者方面具有可比性。与单独使用GERD的频率和持续时间相比，每种工具在区分BE早期肿瘤方面更准确（AuROC，0.667; P <.01）。

结论

HUNT，M-BERET和Kunzmann工具可识别BERO的AuROC值在0.665至0.695之间的患者，并将早期肿瘤的患者与BERO的AuROC值在0.763至0.796之间的患者区分开。这些工具比GERD的频率和持续时间更准确地识别具有肿瘤性BE风险的个体。