Background & Aims

Despite extensive Barrett’s esophagus (BE) screening efforts, most patients with esophageal adenocarcinoma (EAC) present de novo. It is unclear how much of this problem is the result of insensitivity or poor applications of current screening guidelines. We aimed to evaluate the sensitivity of guidelines by determining the proportion of prevalent EAC cases that meet the American College of Gastroenterology (ACG) or the British Society of Gastroenterology (BSG) guidelines for BE screening and determine whether changes to criteria would enhance detection.

Methods

A retrospective single-center cohort from the United States (n = 663) and a prospective multicenter cohort from the United Kingdom (n = 645) were collected and analyzed independently. Screening eligibility was determined as patients with chronic reflux and at least 2 or more risk factors as defined by the guidelines. We calculated the proportion of screening-eligible patients and then compared BE/EAC risk factors between screening-eligible and screening-ineligible patients using the chi-squared or Student t test as appropriate.

Results

In the Mayo clinic cohort there were 54.9% EAC cases and in the UK cohort there were 38.9% EAC cases that were not identified by ACG or BSG screening criteria, respectively. Among patients who did not meet the screening criteria, lack of heartburn was observed in 86.5% in the Mayo clinic cohort and in 61.4% in the UK cohort. Other risk factors that were lacking included obesity (defined as a body mass index of ≥30 kg/m²) and family history of EAC. Eliminating chronic reflux from the ACG/BSG criteria improved eligibility for screening from 45.1% to 81.3% (P < .001) in the Mayo Clinic cohort and from 61.1% (n = 394) to 81.5% (n = 526; P < .001) in the UK cohort. However, reflux may be difficult to ascertain from the history, and by including proton pump inhibitor use status in addition to the BSG criteria, screening eligibility improved by 10.0% in the UK cohort (n = 459; P < .001).

Conclusions

ACG/BSG BE screening guidelines have limited our ability to detect prevalent EAC. An optimized approach to identifying the individuals most suitable for EAC screening needs to be implemented, particularly one that does not rely on chronic reflux symptoms.

中文翻译：

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Barrett 筛查新发食管腺癌时胃灼热和其他社会标准的局限性

背景与目标

尽管进行了广泛的 Barrett 食管 (BE) 筛查工作，但大多数食管腺癌 (EAC) 患者是从头出现的。目前尚不清楚这个问题有多少是由于当前筛查指南的不敏感或应用不当造成的。我们旨在通过确定符合美国胃肠病学会 (ACG) 或英国胃肠病学会 (BSG) BE 筛查指南的流行 EAC 病例的比例来评估指南的敏感性，并确定改变标准是否会提高检测率。

方法

对来自美国的回顾性单中心队列 (n = 663) 和来自英国的前瞻性多中心队列 (n = 645) 进行了独立收集和分析。筛选资格被确定为患有慢性反流和指南定义的至少 2 个或更多风险因素的患者。我们计算了符合筛查条件的患者的比例，然后酌情使用卡方或学生t检验比较了符合筛查条件和不符合筛查条件的患者之间的 BE/EAC 风险因素。

结果

在梅奥诊所队列中，有 54.9% 的 EAC 病例，在英国队列中，分别有 38.9% 的 EAC 病例未被 ACG 或 BSG 筛查标准识别。在不符合筛查标准的患者中，Mayo 诊所队列中 86.5% 和英国队列中 61.4% 的患者没有胃灼热。其他缺乏的风险因素包括肥胖（定义为体重指数≥30 kg/m ²）和 EAC 家族史。从 ACG/BSG 标准中消除慢性反流将梅奥诊所队列中的筛查合格率从 45.1% 提高到 81.3% ( P < .001)，从 61.1% (n = 394) 提高到 81.5% (n = 526; P <.001) 在英国队列中。然而，反流可能难以从病史中确定，并且通过在 BSG 标准之外包括质子泵抑制剂的使用状态，英国队列的筛选资格提高了 10.0%（n = 459；P < .001）。

结论

ACG/BSG BE 筛查指南限制了我们检测流行 EAC 的能力。需要实施一种优化方法来确定最适合 EAC 筛查的个体，尤其是不依赖于慢性反流症状的个体。