S1068 Outcomes and Practice Patterns in Patients with Endoscopically Suspected Barrett’s Esophagus and Negative Biopsies

Introduction: Barrett’s esophagus (BE) is the main precursor to esophageal adenocarcinoma (EAC), a cancer with a 5-year survival under 20%. A common finding is endoscopically suspected BE with negative biopsies. Guidelines recommend a 1-2-year follow-up esophagogastroduodenoscopy (EGD), as an estimated 30% of patients may have BE at follow-up. Furthermore, recommendations about prophylaxis with proton pump inhibitors (PPIs) and further subsequent endoscopies after initial follow-up are lacking. Among patients with endoscopically suspected BE with negative biopsies, we sought to identify rates at which BE was found at initial 1-2-year follow-up EGD or at additional subsequent EGDs past 2 years, follow-up EGD was recommended, and PPI was recommended. Methods: We identified patients ≥18 years of age who underwent EGD with biopsy in 2016. Patients with endoscopically suspected BE and negative biopsies were identified. Suspected BE was defined as salmon-colored mucosa extending ≥1 cm proximal to the squamocolumnar junction. Recommendations for follow-up EGDs and PPI use and subsequent EGD and biopsy results for the 8-year period (2016-2023) following index EGD were analyzed. Results: We identified 145 patients with EGD suspicious for BE with negative biopsies. Of these patients, only 55/145 (37.9%) were advised to repeat EGD, and just 10/145 (6.90%) underwent repeat EGD in the subsequent 1-2 years. PPI was recommended to 78/145 (53.8%) patients. Notably, of patients who underwent repeat EGD in 1-2 years, 3/10 (30%) were found to have BE. An additional 3 patients were found to have BE on EGDs performed greater than 2 years after index EGD. Conclusion: Less than half of patients with endoscopically suspected BE with negative biopsies were advised to undergo follow-up EGD, and <7% underwent follow-up EGD in 1-2 years. This represents a missed opportunity for BE detection. In patients with endoscopically suspected BE with negative biopsies who underwent 1-2-year follow-up EGD, 30% were found to have BE, consistent with prior studies. Notably, an additional 3 patients who underwent one or more EGDs greater than 2 years after index EGD were found to have BE. One of these patients had multiple negative EGDs before an EGD showing BE. The other 2 had BE at first follow-up EGD. These findings require further study, as current guidelines do not recommend continued surveillance if an initial 1-2-year follow-up EGD is negative for BE.