P0412 - Adherence to Barrett's Esophagus Surveillance Guidelines in Relation to Prague Criteria and Seattle Protocol

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

Phi P. Tran, DO

Baylor Scott & White
Temple, TX

Phi P. Tran, DO¹, Anupama Ancha, MD², Alexis Emery, BS¹, Kasey Halila, BS², Matthew Tjahja, MD, MS¹, Mark Shell, DO¹, Christopher Naumann, DO²
¹Baylor Scott & White, Temple, TX; ²Baylor Scott & White Medical Center, Temple, TX

Introduction: Barrett’s Esophagus (BE) is a precancerous condition associated with esophageal adenocarcinoma (EAC). Progression to EAC is associated with poor prognosis, with a 5-year interval survival rate of less than 20%. ACG guidelines for Non-dysplastic Barretts Esophagus (NBDE) includes surveillance endoscopy every 3-5 years. This study aims to evaluate surveillance adherence, adherence to Prague Criteria and Seattle Protocol, and patient characteristics in individuals with BE.

Methods:

This retrospective study incldues patients with newly diagnosed BE at Baylor Scott & White Medical Center between 2016-2022. Demographics, including age at diagnosis, gender, race/ethnicity, BMI, smoking status, history of GERD, and BE were evaluated. Endoscopy and pathology reports were reviewed in patients with histopathologic evidence of BE. Adherence to Prague Criteria and Seattle Protocol were documented. Surveillance interval adherence was defined as patients with NDBE who received EGD every 3-5 years. Multiple logistic regressions and data analyses evaluated the relationship between demographics, practice patterns, and surveillance adherence with progression to dysplasia.

Results: 586 were found to have a new diagnosis of BE, 335 males and 251 females, with median diagnosis age of 65. Initial endoscopy revealed 545 with NDBE, 9 with low grade dysplasia, 13 indeterminate for dysplasia, and 17 with high grade dysplasia. 161 patients had short-segment BE (3 cm or less), compared to 105 with long-segment BE. Adherence to Prague Criteria and Seattle Protocol was 163 patients (27.8%) and 302 patients (51.5%), respectively. Median surveillance interval was 35.5 months, with 149/354 (42.1%) screened within the 3-5 year window. 142/354 (40.1%) were screened in less than 30 months, and only 28/354 (7.9%) screened beyond 60 months. 72 patients were lost to follow up. There were no statistical differences in the rate of adherence with any demographics. However, there was a significant difference in surveillance interval and degree of dysplasia (p-value < 0.0001).

Discussion: Prague Criteria and Seattle Protocol adherence for suspected or confirmed BE remains low, even at large academic centers. Other studies report adherence to Prague Criteria ranges from 27-42% and Seattle Protocol around 24%. There is a concern that patients may be screened for BE too often. Practice patterns and patient demographics do not seem to correlate with progression of BE to dysplasia, though prolonged surveillance intervals may play a role.

Figure: Image A: Practice patterns revealing adherence to Prague Criteria, Seattle Protocol, and Surveillance Intervals.
Image B: Surveillance Interval breakdown, including adherence at less than 36 months, between 36-60 months, and greater than 60 months.

Race	Frequency	Percent
American Indian/ Alaska Native	3	0.51
Asian	2	0.34
Black / African American	22	3.75
Native Hawaiian/ Pacific Islander	1	0.17
Other	20	3.41
White / Caucasian	538	91.81
Frequency Missing = 4

Table: Table 1: Demographics of patients found to have Barretts Esophagus.

Disclosures:

Phi Tran indicated no relevant financial relationships.

Anupama Ancha indicated no relevant financial relationships.

Alexis Emery indicated no relevant financial relationships.

Kasey Halila indicated no relevant financial relationships.

Matthew Tjahja indicated no relevant financial relationships.

Mark Shell indicated no relevant financial relationships.

Christopher Naumann indicated no relevant financial relationships.

Phi P. Tran, DO¹, Anupama Ancha, MD², Alexis Emery, BS¹, Kasey Halila, BS², Matthew Tjahja, MD, MS¹, Mark Shell, DO¹, Christopher Naumann, DO². P0412 - Adherence to Barrett's Esophagus Surveillance Guidelines in Relation to Prague Criteria and Seattle Protocol, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.