S3134 Correlation Between Baseline Neoplasia Detection Rate With Missed Dysplasia/Cancer in Patients With Barrett’s Esophagus Undergoing Upper Endoscopy: A Pooled Analysis

INTRODUCTION: Established quality metrics for the management of patients with Barrett’s esophagus (BE) are lacking. Recently, neoplasia detection rate (NDR) during upper endoscopy (EGD) in BE patients has been proposed as a quality metric, similar to adenoma detection rate used in colonoscopy. However, there are no studies to date that have correlated this metric to any clinical outcomes. Our aim was to perform a pooled analysis of studies to correlate the baseline NDR per study with rates of missed high-grade dysplasia (HGD) and adenocarcinoma (EAC), which we termed post-endoscopy significant esophageal neoplasia (PESEN). METHODS: An extensive search using PubMed and Google scholar was performed to identify studies that report on results of index endoscopy for evaluation of BE, as well as, missed HGD/EAC. NDR was defined as the proportion of BE patients with HGD/EAC detected at the index EGD. Patients referred for endoscopic therapy of BE, those with a prior known diagnosis of HGD/EAC and those presenting with dysphagia were excluded from the NDR calculation. Missed HGD/EAC(PESEN) was defined as the proportion of patients with HGD/EAC diagnosed on a subsequent EGD less than 1-year after the index EGD showing non-dysplastic BE (NDBE) or low grade dysplasia (LGD). NDR and PESEN were extracted from each paper and were correlated using Pearson correlation coefficient. A P-value < 0.05 was considered significant. RESULTS: 5 studies were identified that reported both NDR and PESEN. Total number of patients was 11423, with 62.4% male and mean age of 60.8. Overall NDR was 2% with range from 1% to 11.8%. Overall PESEN at 1 year was 38.1% with range from 14% to 54.5% (Table 1). The correlation coefficient between baseline NDR and PESEN was −0.9 (P = 0.037).Table 1.: Rates of neoplasia detection (NDR) and of missed high grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) per studyCONCLUSION: The results of this study show that a higher baseline NDR in patients with BE significantly correlates with lower rates of PESEN. Thus, NDR should be considered as a quality metric for EGD in patients with BE. More studies are needed to identify factors leading to higher NDR and to establish baseline thresholds to gage the quality of endoscopy.