Performance Characteristics of Screening Criteria to Identify Patients at Risk of Barrett's Esophagus in a Primary Care Setting

Background and Aims: Several criteria have been developed for screening of Barrett's esophagus (BE). Previous studies are limited by analysis in highly selective populations. This study evaluated the performance of 4 criteria in identifying patients with BE from a primary care population. Methods: This was a post-hoc analysis from a previous retrospective study reporting on BE screening rates of eligible patients in a large health system. Patients were included if they were screened in a primary care population for BE, were at risk for BE per 1 of the accepted criteria, and underwent screening with esophagogastroduodenoscopy. Sensitivity for BE was calculated for 4 screening criteria. These included criteria from the American College of Gastroenterology (ACG), American Society of Gastrointestinal Endoscopy (ASGE), European Society of Gastrointestinal Endoscopy (ESGE), and the Kunzmann model. Results: In a primary care population, 1077 patients were screened for BE with an esophagogastroduodenoscopy. BE was found in 105 (9.75%) patients. Positive predictive values and negative predictive values of ACG/ESGE, ASGE, and Kunzmann's criteria for BE on pathology were 9.9% and 90.45%, 9.12% and 89.22%, and 10.84% and 92.29%, respectively. The area under the receiver operating characteristic curve for ACG/ESGE, ASGE, and Kunzmann's criteria was 50.49%, 52.23%, and 54.04%, respectively. There was no statistically significant difference in the presence of BE on pathology among patients who did or did not meet ACG/ESGE, ASGE, or Kunzmann's criteria for BE screening. Conclusion: Current BE screening criteria need optimization in a primary care setting. Use of a combination of criteria might capture the highest number of BE patients.