P0409 - Incidental Downstream Resource Utilization Due to Endoscopic Screening for Barrett’s Esophagus

Matthew T. Harbrecht, MD¹, Maria E. Arasim, ², Yue Liu, ¹, Joel Rubenstein, MD, MS, FACG^3
1University of Michigan, Ann Arbor, MI; ²LTC Charles S. Kettles Veterans Affairs Medical Center & University of Michigan, Ann Arbor, MI; ³LTC Charles S, Kettles Veterans Affairs Medical Center & University of Michigan, Ann Arbor, MI

Introduction: Esophagogastroduodenoscopy (EGD) is the standard of care for screening in Barrett’s Esophagus (BE). Prior screening guidelines for BE have ignored the costs associated with incidental findings leading to additional resource utilization, which could be substantial. Disentangling incidental findings from findings related to symptoms that led to clinically indicated EGDs can be subjective. Therefore, we sought to leverage the findings from a cohort of men who underwent EGD solely for research purposes irrespective of symptoms. We hypothesized that a significant minority of screening EGDs would result in downstream resource utilization.

Methods: We abstracted additional data from subjects in the Newly Diagnosed Barrett’s Esophagus Study, which enrolled 822 men (ages, 50–79 y) undergoing colonoscopy for colorectal cancer screening between 2008 and 2011 to also undergo EGD. We re-abstracted electronic medical records to identify incidental findings for which additional biopsies, prescriptions, or diagnostic tests were ordered. We excluded any biopsies obtained of suspected Barrett’s esophagus, esophageal neoplasia, or erosive esophagitis, or any surveillance EGD or diagnostic testing or treatment performed for esophageal neoplasia. Costs were estimated from 2023 median national Centers for Medicare and Medicaid Services reimbursement and average wholesale price of medications.

Results: Of the 822 patients enrolled, gastric biopsies were obtained in 30.8% of cases (253 patients), of which 39 patients (4.7%) were treated for H. pylori. A repeat EGD was recommended in 16 cases (2.0%), including for follow up of gastric ulcers, stenoses, and concerns for malignancy. A proton pump inhibitor was prescribed or recommended to be prescribed to 93 patients (11.3%). Follow up imaging for any indication was rarely recommended (2 esophagrams, no cross-sectional imaging). The total expected additional cost per screening EGD due to downstream resource utilization for incidental findings is $60.

Discussion: Patients undergoing endoscopic screening for BE can frequently expect to have biopsies obtained for incidental findings and to be prescribed chronic proton pump inhibitors, driving up the cost of screening, with uncertain benefit. Incidental findings infrequently lead to repeat procedures or imaging. These data should be incorporated in future cost-effectiveness analyses of endoscopic screening.



Disclosures:


Matthew T. Harbrecht, MD¹, Maria E. Arasim, ², Yue Liu, ¹, Joel Rubenstein, MD, MS, FACG³. P0409 - Incidental Downstream Resource Utilization Due to Endoscopic Screening for Barrett’s Esophagus, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.