ESTIMATED BURDEN OF SCREENING FOR BARRETT’S ESOPHAGUS IN THE UNITED STATES

Introduction:
Barrett’s esophagus (BE), a pre-malignant precursor of esophageal adenocarcinoma (EAC), when recognized early through screening, could potentially allow for endoscopic surveillance or endoscopic eradication therapy. As such, major GI societies recommend targeted screening for BE based on age, race, obesity, smoking, chronic gastroesophageal reflux disease (GERD) and family history of BE/EAC. However, at-risk population is defined variably across societal recommendations, which has led to ambiguity in defining the potential population eligible for BE screening.

Aim:
To estimate the national burden of BE screen-eligible population in accordance with GI societal recommendations.

Methods:
We used the nationally representative 2012 National Health Interview Survey (NHIS) to estimate the U.S. national burden of BE screening based on guidance documents from four major societies (ACG Guidelines 2022, AGA Clinical Practice Update 2022, ASGE Guidelines 2019, BSG Guidelines 2014). We also estimated the number of screen-eligible patients based on different combinations of risk factors in the entire U.S. adult population. Analyses accounted for complex sampling of NHIS.

Results:
The non-institutionalized population in the U.S. in 2012 was 234,920,670. Of these, 43.6% were age ≥50y, 48.1% were males, 76.1% were non-Hispanic white, 39.9% were ever-smokers (17.9% were current smokers), and 27.3% were obese. Overall, 22.7% reported GERD symptoms in the prior year. Based on GI societies’ BE screening recommendations, the screen-eligible population ranged from 19.7 million (8.4%) based on BSG 2014 recommendations to 120.1 million (51.1%) based on AGA Clinical Practice Update 2022 (Table 1). There was wide variation in the number of risk factors in the screen-eligible population, ranging from 78.1% with ≥2 risk factors to 24.7% with ≥4 risk factors. GERD patients had fewer other risk factors: 19.6% with ≥2 risk factors, and 5.4% with ≥4 risk factors (Figure 1).

Conclusions:
The estimated burden of BE screen-eligible population based on current societal recommendations is high and variable, potentially imposing a considerable resource burden, especially if endoscopic screening is pursued. Better understanding of risks and benefits of screening, precise risk stratification and high-performing, scalable, non-invasive screening modalities are needed to improve appropriate targeting and reduce the burden on patients and resources associated with population-based BE screening.