Use of Appropriate Surveillance for Patients With Nondysplastic Barrett's Esophagus.
Use of Appropriate Surveillance for Patients With Nondysplastic Barrett's Esophagus.
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DOI：
10.1016/j.cgh.2018.01.052
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发表时间：
2018-06
期刊：
影响因子：
--
通讯作者：
Rubenstein JH
中科院分区：
文献类型：
--
作者：
Tavakkoli A;Appelman HD;Beer DG;Madiyal C;Khodadost M;Nofz K;Metko V;Elta G;Wang T;Rubenstein JH
Barrett’s Esophagus (BE) is a precursor to esophageal adenocarcinoma (EAC). Guidelines recommend that patients with nondysplastic BE (NDBE) undergo surveillance endoscopy every 3–5 years. We aimed to identify factors associated with surveillance endoscopy of patients with NDBE and identify trends in appropriate surveillance endoscopy of NDBE at a large tertiary care center. We performed a retrospective analysis of data from a Barrett’s Esophagus Registry, identifying patients with NDBE who underwent endoscopy in 2002 or later. We identified patients with NDBE and collected data on length of BE segment, esophageal lesions, demographic features, medications, histology findings, comorbidities, development of EAC, and dates of follow-up endoscopies. We defined appropriate surveillance as 3–5 years between 2nd and 3rd endoscopies, over-users as patients who had less than 3 years between their 2nd and 3rd endoscopies, under-users as patients who had more than 5 years between their 2nd and 3rd endoscopies; and no surveillance as patients who never received a 2nd endoscopy. The primary outcomes were effects of patient factors, year, and referring providers on appropriateness of surveillance intervals. We identified 477 patients with NDBE. Only 15.9% had appropriate surveillance; 37.9% had surveillance overuse, 15.7% had surveillance underuse, and 30.4% received no surveillance. Patients were less likely to be surveillance over-users if their primary care physician referred them for their 3rd endoscopy instead of a gastroenterologist (adjusted odds ratio, 0.51; 95% CI, 0.27–0.95). Male patients or those with an increased number of comorbidities were more likely to have surveillance underuse or no surveillance, whereas patients with long BE segment were more likely to have surveillance overuse. In a retrospective analysis of data from a registry of patients with BE, we found that less than 16% receive appropriate surveillance for NDBE. A primary care provider in the same health system as the endoscopy clinic reduced risk of over-surveillance. This could reflect better coordination of care between specialists and primary care providers
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