Enhancing risk-based Barrett’s esophagus screening through streamlined referral pathways

Not All Dysplastic Barrett's Esophagus Should Be Treated." 1 The call for a more selective approach to endoscopic eradication therapy is timely and clinically important.As Dr Trindade notes, not all dysplastic Barrett's esophagus (BE) follows the same biological course, and treatment of all cases may expose patients to unnecessary risk while straining health care resources.Our institutional experience highlights a critical upstream issue that affects these downstream management decisions: identifying and referring patients who meet criteria for BE screening. 2We surveyed 44 internal medicine residents and attendings regarding BE screening practices.Although 61.3% reported awareness of guideline recommendations for BE surveillance, fewer than two-thirds felt confident in assessing risk factors that would prompt patient referral for open-access endoscopy.Importantly, 97.7% indicated that a structured electronic health record prompt summarizing BE risk factors would make clinicians more likely to refer eligible patients for esophagogastroduodenoscopy.This suggests that even when physicians are knowledgeable, clinical and institutional barriers in workflow can hinder screening implementation.These data reinforce that thoughtful management of dysplastic BE depends not only on selective treatment, as Dr Trindade advocates, but also on appropriate case identification.Strengthening collaboration between primary care and gastroenterology, through education, electronic health record tools, and standardized referral prompts, can improve risk-based screening and ensure that endoscopic eradication therapy decisions are applied to the right patients.