Improving screening practices for Barrett's esophagus.
This article reviews the epidemiology of Barrett's esophagus (BE) and current evidence for or against screening for BE to provide insight into the screening process. Data demonstrate that multiple criteria of a successful screening program remain unfulfilled or unproven in endoscopic screening for BE. The operating characteristics of the test are poorly described, and inadequate risk stratification limits the effectiveness and cost-effectiveness of the approach. We suggest modifications to BE screening practices that may have the potential to improve outcomes for patients with BE.
Shaheen
Nicholas J
NJ
Departments of Medicine and Epidemiology, Schools of Medicine and Public Health, CB#7080, UNC-CH, Chapel Hill, NC 27599-7080, USA. nshaheen@med.unc.edu
Palmer
Lena B
LB
D000230:Adenocarcinoma / Q000453:epidemiology / Q000209:etiology; D001471:Barrett Esophagus / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D015982:Bias; D001706:Biopsy; D003362:Cost-Benefit Analysis; D042241:Early Diagnosis; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000209:etiology; D004945:Esophagoscopy; D055317:Evidence-Based Practice; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods* / Q000592:standards; D009765:Obesity / Q000150:complications; D011230:Precancerous Conditions / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017749:Total Quality Management; D016896:Treatment Outcome