University of Colorado School of Medicine, Division of Gastroenterology and Hepatology, Anschutz Medical Campus, Aurora, Colorado, USA.
GI Quality Improvement Consortium, Bethesda, Maryland, USA.
Am J Gastroenterol. 2021 Jun 1;116(6):1201-1210. doi: 10.14309/ajg.0000000000001230.
Racial disparities in outcomes in esophageal adenocarcinoma are well established. Using a nationwide registry, we aimed to compare clinical and endoscopic characteristics of blacks and whites with Barrett's esophagus (BE) and adherence to defined quality indicators.
We analyzed data from the Gastrointestinal Quality Improvement Consortium Registry between January 2012 and December 2019. Patients who underwent esophagogastroduodenoscopy with an indication of BE screening or surveillance, or an endoscopic finding of BE, were included. Adherence to recommended endoscopic surveillance intervals of 3-5 years for nondysplastic BE and adherence to Seattle biopsy protocol were assessed. Multivariate logistic regression was conducted to assess variables associated with adherence.
A total of 100,848 esophagogastroduodenoscopies in 84,789 patients met inclusion criteria (blacks-3,957 and whites-96,891). Blacks were less likely to have histologically confirmed BE (34.3% vs 51.7%, P < 0.01), had shorter BE lengths (1.61 vs 2.35 cm, P < 0.01), and were less likely to have any dysplasia (4.3% vs 7.1%, P < 0.01). Although whites were predominantly male (62.2%), about half of blacks with BE were female (53.0%). Blacks with nondysplastic BE were less likely to be recommended appropriate surveillance intervals (OR 0.78; 95% CI 0.68-0.89). Adherence rates to the Seattle protocol were modestly higher among blacks overall (OR 1.12, 95% CI 1.04-1.20), although significantly lower among blacks with BE segments >6 cm.
The use of sex as a risk factor for BE screening may be inappropriate among blacks. Fewer blacks were recommended appropriate surveillance intervals, and blacks with longer segment BE were less likely to undergo Seattle biopsy protocol.
食管腺癌的结局存在明显的种族差异。本研究利用全国性登记处的数据，旨在比较黑人与白人 Barrett 食管（BE）患者的临床和内镜特征，并评估其对既定质量指标的依从性。
我们分析了 2012 年 1 月至 2019 年 12 月期间胃肠质量改进联盟登记处的数据。纳入行食管胃十二指肠镜检查且有 BE 筛查或监测指征，或内镜发现 BE 的患者。评估无异型增生 BE 的推荐内镜监测间隔（3-5 年）和西雅图活检方案的依从性。采用多变量逻辑回归分析评估与依从性相关的变量。
共纳入 84789 例患者的 100848 次食管胃十二指肠镜检查（黑人 3957 例，白人 96891 例）。黑人患者组织学证实 BE 的比例较低（34.3% vs. 51.7%，P < 0.01），BE 长度较短（1.61 cm vs. 2.35 cm，P < 0.01），且任何程度异型增生的比例较低（4.3% vs. 7.1%，P < 0.01）。虽然白人患者以男性为主（62.2%），但约一半的黑人 BE 患者为女性（53.0%）。无异型增生 BE 的黑人患者推荐适当监测间隔的可能性较低（比值比 0.78；95%可信区间 0.68-0.89）。总体而言，黑人患者接受西雅图方案的比例略高（比值比 1.12；95%可信区间 1.04-1.20），但 BE 段长度>6 cm 的黑人患者接受西雅图方案的比例显著较低。
将性别作为 BE 筛查的危险因素可能不适用于黑人。黑人患者推荐适当监测间隔的比例较低，且 BE 段较长的黑人患者更不可能接受西雅图活检方案。
