Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, 10900 Euclid Ave, WOM WG-57, Cleveland, OH, 44106, USA.
Department of Pathology and Lab Medicine, Tufts University School of Medicine, Boston, MA, USA.
Esophagus. 2023 Jan;20(1):143-149. doi: 10.1007/s10388-022-00943-4. Epub 2022 Jul 22.
Screening for Barrett's esophagus (BE) with endoscopy plus forceps biopsy (FB) has poor compliance with the recommended Seattle protocol and fails to sample large areas of mucosa. This statistical modeling study estimates, for the first time, the actual frequency of missed BE cases by FB.
Published, calibrated models in the literature were combined to calculate the age-specific prevalence of BE in white males with gastroesophageal reflux disease (GERD). We started with estimates of the prevalence of BE and GERD, and applied the relative risk for BE in patients with GERD based on the literature. This created estimates of the true prevalence of BE in white males with GERD by decade of life. The proportion of BE missed was calculated as the difference between the prevalence and the proportion with a positive screen.
The prevalence of BE in white males with GERD was 8.9%, 12.1%, 15.3%, 18.7% and 22.0% for the third through eighth decades of life. Even after assuming no false positives, missed cases of BE were about 50% when estimated for patients of ages 50 or 60 years, and over 60% for ages of 30, 40 or 70 years. Sensitivity analysis was done for all variables in the model calculations. For ages 50 and 60 years, this resulted in values from 30.3 to 57.3% and 36.4 to 60.9%.
Screening for BE with endoscopy and FB misses approximately 50% of BE cases. More sensitive methods of BE detection or better adherence to the Seattle protocol are needed.
内镜加活检钳（FB）筛查 Barrett 食管（BE）对推荐的西雅图方案的依从性较差，无法对大面积黏膜进行取样。这项统计建模研究首次估计了 FB 漏诊 BE 病例的实际频率。
我们结合文献中已发表的校准模型，计算出患有胃食管反流病（GERD）的白种男性中 BE 的年龄特异性患病率。我们从 BE 和 GERD 的患病率估计值开始，并根据文献中的 GERD 患者 BE 的相对风险进行计算。这就创建了 GERD 白种男性一生中每十年 BE 的真实患病率估计值。将漏诊 BE 的比例计算为患病率与阳性筛查比例之间的差值。
患有 GERD 的白种男性中 BE 的患病率在第三至第八个十年分别为 8.9%、12.1%、15.3%、18.7%和 22.0%。即使假设没有假阳性，当估计年龄为 50 或 60 岁的患者时，BE 的漏诊病例约为 50%，而年龄为 30、40 或 70 岁时，漏诊病例超过 60%。对模型计算中的所有变量进行了敏感性分析。对于 50 和 60 岁的年龄组，结果分别为 30.3%至 57.3%和 36.4%至 60.9%。
用内镜和 FB 筛查 BE 会漏诊约 50%的 BE 病例。需要更敏感的 BE 检测方法或更好地遵循西雅图方案。
