Mendel E Singer1, Robert D Odze2. 1. Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, 10900 Euclid Ave, WOM WG-57, Cleveland, OH, 44106, USA. mendel@case.edu. 2. Department of Pathology and Lab Medicine, Tufts University School of Medicine, Boston, MA, USA.
Abstract
BACKGROUND: Screening for Barrett's esophagus (BE) with endoscopy plus forceps biopsy (FB) has poor compliance with the recommended Seattle protocol and fails to sample large areas of mucosa. This statistical modeling study estimates, for the first time, the actual frequency of missed BE cases by FB. METHODS: Published, calibrated models in the literature were combined to calculate the age-specific prevalence of BE in white males with gastroesophageal reflux disease (GERD). We started with estimates of the prevalence of BE and GERD, and applied the relative risk for BE in patients with GERD based on the literature. This created estimates of the true prevalence of BE in white males with GERD by decade of life. The proportion of BE missed was calculated as the difference between the prevalence and the proportion with a positive screen. RESULTS: The prevalence of BE in white males with GERD was 8.9%, 12.1%, 15.3%, 18.7% and 22.0% for the third through eighth decades of life. Even after assuming no false positives, missed cases of BE were about 50% when estimated for patients of ages 50 or 60 years, and over 60% for ages of 30, 40 or 70 years. Sensitivity analysis was done for all variables in the model calculations. For ages 50 and 60 years, this resulted in values from 30.3 to 57.3% and 36.4 to 60.9%. CONCLUSION: Screening for BE with endoscopy and FB misses approximately 50% of BE cases. More sensitive methods of BE detection or better adherence to the Seattle protocol are needed.
BACKGROUND: Screening for Barrett's esophagus (BE) with endoscopy plus forceps biopsy (FB) has poor compliance with the recommended Seattle protocol and fails to sample large areas of mucosa. This statistical modeling study estimates, for the first time, the actual frequency of missed BE cases by FB. METHODS: Published, calibrated models in the literature were combined to calculate the age-specific prevalence of BE in white males with gastroesophageal reflux disease (GERD). We started with estimates of the prevalence of BE and GERD, and applied the relative risk for BE in patients with GERD based on the literature. This created estimates of the true prevalence of BE in white males with GERD by decade of life. The proportion of BE missed was calculated as the difference between the prevalence and the proportion with a positive screen. RESULTS: The prevalence of BE in white males with GERD was 8.9%, 12.1%, 15.3%, 18.7% and 22.0% for the third through eighth decades of life. Even after assuming no false positives, missed cases of BE were about 50% when estimated for patients of ages 50 or 60 years, and over 60% for ages of 30, 40 or 70 years. Sensitivity analysis was done for all variables in the model calculations. For ages 50 and 60 years, this resulted in values from 30.3 to 57.3% and 36.4 to 60.9%. CONCLUSION: Screening for BE with endoscopy and FB misses approximately 50% of BE cases. More sensitive methods of BE detection or better adherence to the Seattle protocol are needed.
Authors: Wayne A Phillips; Reginald V Lord; Derek J Nancarrow; David I Watson; David C Whiteman Journal: J Gastroenterol Hepatol Date: 2011-04 Impact factor: 4.029
Authors: Julian A Abrams; Robert C Kapel; Guy M Lindberg; Mohammad H Saboorian; Robert M Genta; Alfred I Neugut; Charles J Lightdale Journal: Clin Gastroenterol Hepatol Date: 2009-01-13 Impact factor: 11.382
Authors: Stuart J Spechler; Prateek Sharma; Rhonda F Souza; John M Inadomi; Nicholas J Shaheen Journal: Gastroenterology Date: 2011-03 Impact factor: 22.682
Authors: Chin Hur; Tristan J Hayeck; Jennifer M Yeh; Ethan M Richards; Ethan B Richards; Stuart J Spechler; G Scott Gazelle; Chung Yin Kong Journal: PLoS One Date: 2010-03-01 Impact factor: 3.240
Authors: Zhang Haiyu; Pei Xiaofeng; Mo Xiangqiong; Qiu Junlan; Zheng Xiaobin; Wang Shuncong; Sun Huanhuan; Ma Haiqing Journal: Biomed Res Int Date: 2019-12-12 Impact factor: 3.411