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Research Letter
March 2014

Use and Yield of Endoscopy in Patients With Uncomplicated Gastroesophageal Reflux Disorder

Author Affiliations
  • 1Center for Innovations in Quality, Effectiveness, and Safety, VA Health Services Research & Development, Washington, DC
  • 2Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
  • 3Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
  • 4Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
JAMA Intern Med. 2014;174(3):462-465. doi:10.1001/jamainternmed.2013.13015

Practice guidelines recommend esophagogastroduodenoscopy (EGD) screening for Barrett esophagus (BE) or esophageal cancer for patients with uncomplicated gastroesophageal reflux disease (GERD), especially in high-risk patients (symptoms for >5 years, white race, male sex, age >50 years, and family history of BE or esophageal cancer).1,2 However, the extent of using screening EGD, its predictors, and diagnostic yield are unclear. We aimed to determine prevalence, predictors, and yield of screening EGD in a large national sample of patients with uncomplicated GERD.

This study was approved by the Baylor College of Medicine Institutional Review Board and Michael E. DeBakey VA Medical Center Research and Development. This was a retrospective cohort study using national administrative (Medical SAS Inpatient and Outpatient Data sets and Decision Support System Clinical Laboratory Results and Pharmacy National Data Extracts) and clinical data (Computerized Patient Record System) from the US Department of Veterans Affairs (VA).3 Patients with a first International Classification of Diseases, Ninth Revision (ICD-9) code in 2004 through 2009 for uncomplicated GERD (ie, without alarm symptoms or signs of anemia, decompensated liver disease, gastrointestinal tract [GI] bleeding, celiac disease, any metastatic cancer, or any chemotherapy) were included. Outcomes were receipt of screening EGD (Current Procedural Terminology [CPT] codes) and yield for BE (ICD-9 code of BE combined with EGD) and esophageal, gastric, or duodenal cancer (E/GC) (all validated by medical chart review). Predictors of these outcomes, including demographic, clinical, clinical care, and facility factors (Table), were examined using hierarchical logistic regression models with a random effect for the clustering of patients within individual facilities.