Health Services Research & Development

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Hammad TA, Thrift AP, El-Serag HB, Husain NS. Missed Opportunities for Screening and Surveillance of Barrett's Esophagus in Veterans with Esophageal Adenocarcinoma. Digestive diseases and sciences. 2019 Feb 1; 64(2):367-372.
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Abstract: BACKGROUND: Barrett''s esophagus (BE) is the premalignant lesion of esophageal adenocarcinoma (EAC) and is the target of early detection and prevention efforts for EAC. AIMS: We sought to evaluate what proportion and temporal trends of EAC patients had missed opportunities for screening and surveillance of BE. METHODS: Our study included 182 patients with EAC at the Michael E. DeBakey VA Medical Center in Houston, Texas, between 02/2005 and 09/2017. We conducted a retrospective audit of patients'' medical records for any previous upper endoscopies (EGDs) for screening or surveillance of BE prior to their EAC diagnosis. RESULTS: The mean age of the cohort was 67.3 years (SD?=?9.5); 99.5% of patients were male, and 85.2% were white. Only 45 patients (24.7%) had EGD at any time prior to the cancer diagnosing EGD, of whom 29 (15.9% of all EAC cases) had an established BE diagnosis. In the 137 patients with no prior EGD, most (63.5%) had GERD or were obese or ever smokers. There were no changes in patterns over time. For the 29 patients with prior established BE, 22 (75.8%) were diagnosed with EAC as a result of surveillance EGD. Patients with prior established BE were more likely to be diagnosed at 0 or I stage (p?