title: Practice patterns of surveillance endoscopy in a Veterans Affairs database of 29,504 patients with Barrett's esophagus.
abstract: BACKGROUND
  Practice guidelines recommend surveillance endoscopy every 2 to 3 years among patients with Barrett's esophagus (BE) to detect early neoplastic lesions. Although surveys report that >95% of gastroenterologists recommend or practice BE surveillance, the extent and patterns of surveillance in clinical practice are unknown.
  
  
  OBJECTIVE
  To identify the extent and determinants of endoscopic surveillance among BE patients.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A total of 121 Veterans Affairs facilities nationwide.
  
  
  METHODS
  Veteran patients with BE diagnosed from 2003 to 2009, with follow-up through September 30, 2010.
  
  
  METHODS
  Not an interventional study.
  
  
  METHODS
  The proportions of patients with BE who received any EGD after the index BE EGD date. In the subgroup of patients with at least 6 years of follow-up, we also calculated proportions for regular (EGD during both 3-year intervals), irregular (EGD in only 1 interval), and no surveillance. We examined differences in demographics and clinical and facility factors among these groups in unadjusted and adjusted analyses.
  
  
  RESULTS
  We identified 29,504 patients with BE; 97% were men, 83% white, and their mean age was 61.8 years. During a 3.8-year median follow-up period, 45.4% of patients with BE received at least one EGD. Among the subgroup of 4499 patients with BE who had at least 6 years of follow-up, 23.0% had regular surveillance, and 26.7% had irregular surveillance. There was considerable facility-level variation in percentages with surveillance EGD across the 112 facilities and by geographic region of these facilities. Demographic and clinical factors did not explain these variations. Patients with at least one EGD were significantly more likely to be white; to be aged <65 years, with a low level of comorbidity; to have GERD, obesity, dysphagia, or esophageal strictures; to have more outpatient visits; and to be seen in smaller hospitals (<87 beds) than those without any EGD.
  
  
  CONCLUSIONS
  There might be misclassification of BE and surveillance EGD. Lack of pathology data on dysplasia, which dictates surveillance intervals.
  
  
  CONCLUSIONS
  Endoscopic surveillance for BE is considerably less commonly practiced in Veterans Affairs facilities than is self-reported by physicians. Although several clinical factors are associated with variations in surveillance, facility-level factors play a large role. The comparative effectiveness of the different practice-based surveillance patterns needs to be examined.
authors.affiliation: The Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd (152), Houston, TX 77030, USA. hasheme@bcm.edu
authors.forename: Hashem B
authors.initials: HB
authors.lastname: El-Serag
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Duan
authors.forename: Marilyn
authors.initials: M
authors.lastname: Hinojosa-Lindsey
authors.forename: Jason
authors.initials: J
authors.lastname: Hou
authors.forename: Mohammad
authors.initials: M
authors.lastname: Shakhatreh
authors.forename: Aanand D
authors.initials: AD
authors.lastname: Naik
authors.forename: G John
authors.initials: GJ
authors.lastname: Chen
authors.forename: Richard L
authors.initials: RL
authors.lastname: Street
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Kramer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology*; D057186:Comparative Effectiveness Research; D016208:Databases, Factual; D016145:Endoscopy, Digestive System / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs