Neoplasia Detection Rate Can Be Used as a Quality Indicator for Endoscopy in Barrett’s Esophagus

Standardized quality metrics evaluating the performance of a high-quality examination in patients with Barrett’s esophagus are lacking. The neoplasia detection rate (NDR), defined as the rate of high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) detected during index screening endoscopy, has been proposed as a quality measure for upper endoscopy, much like the adenoma detection rate is used for colorectal cancer screening. However, data are lacking to show relevant clinical outcomes tied to using the NDR as a quality measure. This study aimed to compare the NDR to postendoscopy Barrett’s neoplasia (PEBN) rates 1 year after index endoscopy.

This systematic review and meta-analysis included 10 studies with 27,894 patients (63% male) undergoing index screening endoscopy. A total of 1636 patients were diagnosed with high-grade dysplasia or EAC at index endoscopy for a pooled NDR rate of 5.0% (95% confidence interval [CI], 3.4%-7.1%). In addition, 314 patients were diagnosed with HGD or EAC within 1 year of index endoscopy for a pooled PEBN rate of 19.6% (95% CI, 10.1%-34.7%). Upon meta-regression analysis, a significant inverse correlation was found between baseline NDR and PEBN rates (coefficient, -3.5; 95% CI, -4.63 to -2.37; P<.01). This was consistent when adjusted for age and gender (P<.01), and there was no difference when adjusted for location (P=.55), practice setting (P=.31), or study quality (P=.42). When the PEBN rate was compared at NDR thresholds of <5% and ≥5%, there was a 2-fold increase in PEBN (28.4%, 5 studies; 95% CI, 14.6%-47.9%) if the NDR was <5%, compared to PEBN for NDR ≥5% (12.8%, 5 studies; 95% CI, 5.9%-25.6%).