P0322 - "Incidental" Barrett's Esophagus (BE) Is More Common and More Dangerous Than BE Detected by Screening Exams: A Study From the GIQuIC National Quality Benchmarking Registry

Sachin Wani, MD¹, J. Lucas Williams, MPH², Jennifer Holub, MPH², Christian Davis, MD³, Jennifer Kolb, MD, MS⁴, Nicholas Shaheen, MD^5
1University of Colorado Anschutz Medical Campus, Aurora, CO; ²GI Quality Improvement Consortium, Bethesda, MD; ³University of Colorado School of Medicine, Denver, CO; ⁴University of California Irvine, Orange, CA; ⁵University of North Carolina at Chapel Hill, Chapel Hill, NC

Introduction: “Incidental” BE, defined as BE diagnosed during exams for reasons other than BE screening or surveillance, has an unknown incidence and outcomes. Sampling strategies, rates of detection of dysplasia/EAC and surveillance endoscopy recommendations in “incidental” BE, compared to BE detected during screening or surveillance, has not been described.

Methods: We analyzed data from the GI Quality Improvement Consortium (GIQuIC), a national benchmarking data registry. Upper endoscopy data (1/2018-5/2021) include procedure indication, demographics, endoscopy findings, pathology results, and recommendations for future endoscopy. Patients with endoscopic and histological findings of BE were included in this analysis and indications were categorized as: (i) BE screening, (ii) BE surveillance and (iii) non-BE related (“incidental BE”). Outcomes included neoplasia detection rate [NDR, defined as high-grade dysplasia (HGD)/EAC], adherence to Seattle biopsy protocol and 3-5 year surveillance interval in non-dysplastic BE (NDBE) patients based on indication. Adherence to Seattle protocol was defined by dividing the BE length by number of pathology jars, with a ratio of ≤2.0 with (rounding down for odd BE lengths) considered adherent.

Results: A total of 415,883 EGDs were assessed, and 20,155 (4.8%) EGDs performed by 1195 endoscopists across 255 practices had findings of BE [mean age 62.5 yrs (SD 12.7), 61.3% male, 91.5% Caucasian, mean BE length 2.3 (SD 2.8)]. The overall adherence rate to the Seattle biopsy protocol was 86.1% and nearly 30% were non-adherent to the 3-5 year surveillance interval for NDBE. In this cohort, 209 patients were diagnosed with HGD/EAC (NDR 1%) and 692 (3.4%) patients with any dysplasia or EAC. Table highlights study outcomes stratified by indication. "Incidental" BE patients were greater in number, and twice as likely to have HGD/EAC compared to BE diagnosed during screening exams (p< 0.01) despite having lower adherence rates to the Seattle biopsy protocol (p< 0.01). Nearly 37% of incidental BE are not adherent to surveillance interval recommendations.

Discussion: “Incidental” BE is remarkably common and more likely to harbor HGD/EAC than screening/surveillance exams. Despite being enriched for dysplasia, exams with incidental BE had low adherence rates to the Seattle biopsy protocol. These results highlight the importance of adequate inspection and sampling of BE regardless of the indication of the procedure.

Outcome	Incidental BE n=5222	BE during screening n=4728	BE surveillance n=9636	p value Incidental BE vs. BE screening	p value Incidental BE vs. BE surveillance	p value screening vs. surveillance
Neoplasia detection rate (HGD/EAC) (n, %)	80 (1.5%)	31 (0.7%)	94 (1%)	< 0.001	0.002	0.05
Any dysplasia/EAC (n, %)	170 (3.3%)	94 (2%)	408 (4.2%)	< 0.001	0.58	< 0.001
Adherence to Seattle protocol (n, %)	4365/5235 (83.4%)	4301/4734 (91%)	8284/9625 (86.1%)	< 0.001	< 0.001	< 0.001
Adherence to 3-5 yr surveillance in NDBE (n, %)	1933/3089 (62.6%)	1782/2822 (63.1%)	4465/5630 (79.3%)	0.65	< 0.001	< 0.001

Table: Detection of Barrett’s related dysplasia and esophageal adenocarcinoma (EAC) and adherence to Seattle biopsy protocol and 3-5 year surveillance endoscopy recommendation in non-dysplastic Barrett’s esophagus (NDBE) in this cohort of 20,155 patients with suspected or established BE, based on indication


Disclosures:
Sachin Wani: Ambu – Grant/Research Support. Cernostics – Advisory Committee/Board Member. Exact Sciences – Consultant. Lucid – Grant/Research Support.
J. Lucas Williams indicated no relevant financial relationships.
Jennifer Holub indicated no relevant financial relationships.
Christian Davis indicated no relevant financial relationships.
Jennifer Kolb indicated no relevant financial relationships.
Nicholas Shaheen: CDx – Grant/Research Support. Cernostics – Advisory Committee/Board Member. Cook Medical – Consultant. Exact Sciences – Consultant. Interpace – Grant/Research Support. Lucid – Grant/Research Support. Medtronic – Grant/Research Support. Pentax – Grant/Research Support. Phathom Pharmaceuticals – Consultant. Steris – Grant/Research Support.


Sachin Wani, MD¹, J. Lucas Williams, MPH², Jennifer Holub, MPH², Christian Davis, MD³, Jennifer Kolb, MD, MS⁴, Nicholas Shaheen, MD⁵. P0322 - "Incidental" Barrett's Esophagus (BE) Is More Common and More Dangerous Than BE Detected by Screening Exams: A Study From the GIQuIC National Quality Benchmarking Registry, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.