P4945 - Outcomes and Practice Patterns in Patients with Endoscopically Suspected Barrett’s Esophagus and Negative Biopsies

Susie J. Park, MD¹, Abdelrhman Refaey, MD², Ahmed Mohamed Ebeid, MD³, Pavan Vemulakonda, MD¹, Robert Gordon, DO⁴, Mrudula Bandaru, MD⁴, Zeina Bani Hani, MBBS¹, Asil Alsaad, MD⁵, Ahmed Attia, MD¹, Valerie S. Stark, MD, MPH⁴, Omar Saadi, BS¹, Ishan Abdullah, BS¹, Mariam Hafez, BS¹, Sandy Awad, BS¹, Maxwell Madani, BA¹, Calvin Tabetah, MD¹, Athanasios S. Naum, BS¹, Laxmikausthubha Yaratha, MD¹, Kris Kokoneshi, BA¹, Lucas Miecho. Heilbroner, BA¹, Marie L. Borum, MD, EdD, MPH, FACG², Samuel A. Schueler, MD²
1George Washington University School of Medicine and Health Sciences, Washington, DC; 2Division of Gastroenterology and Liver Disease, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC; 3Howard University Hospital, Washington, DC; 4Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC; 5Transplant Institute, Department of Surgery, George Washington University School of Medicine and Health Science, Washington, DC

Introduction: Barrett’s esophagus (BE) is the main precursor to esophageal adenocarcinoma (EAC), a cancer with a 5-year survival under 20%. A common finding is endoscopically suspected BE with negative biopsies. Guidelines recommend a 1–2-year follow-up esophagogastroduodenoscopy (EGD), as an estimated 30% of patients may have BE at follow-up. Furthermore, recommendations about prophylaxis with proton pump inhibitors (PPIs) and further subsequent endoscopies after initial follow-up are lacking. Among patients with endoscopically suspected BE with negative biopsies, we sought to identify rates at which 1) BE was found at initial 1-2-year follow-up EGD or at additional subsequent EGDs past 2 years; 2) follow-up EGD was recommended and 3) PPI was recommended.

Methods: We identified patients ≥18 years of age who underwent EGD with biopsy in 2016. Patients with endoscopically suspected BE and negative biopsies were identified. Suspected BE was defined as salmon-colored mucosa extending ≥ 1 centimeter proximal to the squamocolumnar junction. Recommendations for follow-up EGDs and PPI use and subsequent EGD and biopsy results for the 8-year period (2016-2023) following index EGD were analyzed.

Results: We identified 145 patients with EGD suspicious for BE with negative biopsies. Of these patients, only 55/145 (37.9%) were advised to repeat EGD, and just 10/145 (6.90%) underwent repeat EGD in the subsequent 1–2 years. PPI was recommended to 78/145 (53.8%) patients. Notably, of patients who underwent repeat EGD in 1-2 years, 3/10 (30%) were found to have BE. An additional 3 patients were found to have BE on EGDs performed greater than 2 years after index EGD.

Discussion: Less than half of patients with endoscopically suspected BE with negative biopsies were advised to undergo follow-up EGD, and less than seven percent underwent follow-up EGD in 1-2 years. This represents a missed opportunity for BE detection. In patients with endoscopically suspected BE with negative biopsies who underwent 1–2-year follow-up EGD, 30% were found to have BE, consistent with prior studies. Notably, an additional 3 patients who underwent one or more EGDs greater than 2 years after index EGD were found to have BE. One of these patients had multiple negative EGDs before an EGD showing BE. The other two had BE at first follow-up EGD. These findings require further study, as current guidelines do not recommend continued surveillance if an initial 1-2-year follow-up EGD is negative for BE

Disclosures:
Susie Park indicated no relevant financial relationships.
Abdelrhman Refaey indicated no relevant financial relationships.
Ahmed Mohamed Ebeid indicated no relevant financial relationships.
Pavan Vemulakonda indicated no relevant financial relationships.
Robert Gordon indicated no relevant financial relationships.
Mrudula Bandaru indicated no relevant financial relationships.
Zeina Bani Hani indicated no relevant financial relationships.
Asil Alsaad indicated no relevant financial relationships.
Ahmed Attia indicated no relevant financial relationships.
Valerie Stark indicated no relevant financial relationships.
Omar Saadi indicated no relevant financial relationships.
Ishan Abdullah indicated no relevant financial relationships.
Mariam Hafez indicated no relevant financial relationships.
Sandy Awad indicated no relevant financial relationships.
Maxwell Madani indicated no relevant financial relationships.
Calvin Tabetah indicated no relevant financial relationships.
Athanasios Naum indicated no relevant financial relationships.
Laxmikausthubha Yaratha indicated no relevant financial relationships.
Kris Kokoneshi indicated no relevant financial relationships.
Lucas Heilbroner indicated no relevant financial relationships.
Marie Borum indicated no relevant financial relationships.
Samuel Schueler indicated no relevant financial relationships.

Susie J. Park, MD¹, Abdelrhman Refaey, MD², Ahmed Mohamed Ebeid, MD³, Pavan Vemulakonda, MD¹, Robert Gordon, DO⁴, Mrudula Bandaru, MD⁴, Zeina Bani Hani, MBBS¹, Asil Alsaad, MD⁵, Ahmed Attia, MD¹, Valerie S. Stark, MD, MPH⁴, Omar Saadi, BS¹, Ishan Abdullah, BS¹, Mariam Hafez, BS¹, Sandy Awad, BS¹, Maxwell Madani, BA¹, Calvin Tabetah, MD¹, Athanasios S. Naum, BS¹, Laxmikausthubha Yaratha, MD¹, Kris Kokoneshi, BA¹, Lucas Miecho. Heilbroner, BA¹, Marie L. Borum, MD, EdD, MPH, FACG², Samuel A. Schueler, MD². P4945 - Outcomes and Practice Patterns in Patients with Endoscopically Suspected Barrett’s Esophagus and Negative Biopsies, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.