Performance Characteristics of Screening Criteria to Identify Patients at Risk of Barrett's Esophagus in a Primary Care Setting

Abstract

Background and Aims

Several criteria have been developed for screening of Barrett's esophagus (BE). Previous studies are limited by analysis in highly selective populations. This study evaluated the performance of 4 criteria in identifying patients with BE from a primary care population.

Methods

This was a post-hoc analysis from a previous retrospective study reporting on BE screening rates of eligible patients in a large health system. Patients were included if they were screened in a primary care population for BE, were at risk for BE per 1 of the accepted criteria, and underwent screening with esophagogastroduodenoscopy. Sensitivity for BE was calculated for 4 screening criteria. These included criteria from the American College of Gastroenterology (ACG), American Society of Gastrointestinal Endoscopy (ASGE), European Society of Gastrointestinal Endoscopy (ESGE), and the Kunzmann model.

Results

In a primary care population, 1077 patients were screened for BE with an esophagogastroduodenoscopy. BE was found in 105 (9.75%) patients. Positive predictive values and negative predictive values of ACG/ESGE, ASGE, and Kunzmann's criteria for BE on pathology were 9.9% and 90.45%, 9.12% and 89.22%, and 10.84% and 92.29%, respectively. The area under the receiver operating characteristic curve for ACG/ESGE, ASGE, and Kunzmann's criteria was 50.49%, 52.23%, and 54.04%, respectively. There was no statistically significant difference in the presence of BE on pathology among patients who did or did not meet ACG/ESGE, ASGE, or Kunzmann's criteria for BE screening.

Conclusion

Current BE screening criteria need optimization in a primary care setting. Use of a combination of criteria might capture the highest number of BE patients.