2867 Barrett's Esophagus Screening: A Survey of Primary Care Physicians to Assess Knowledge Gaps

Abstract

INTRODUCTION: Barrett’s esophagus (BE) is a condition in which metaplastic columnar epithelium with goblet cells replaces the stratified squamous epithelium normally found in the distal esophagus. It is a precursor for esophageal adenocarcinoma (EAC), however screening for BE remains a controversial topic and any guidelines that exist may not be well known among primary care physicians (PCPs). The transformation from nondysplastic BE to EAC has a slow rate of progression, giving screening for BE the potential to identify patients earlier via endoscopic visualization and confirmatory biopsy. A prior study found that less than 5% of patients undergoing resection for EAC had a prior diagnosis of BE, 1 indicating potential missed opportunities for screening of appropriate patients. Newer data recommends selective screening via stratification of patients based on risk factors. PCPs are often a patients first line of contact within the healthcare system; therefore, they should have an thorough understanding of the risk factors for BE and be comfortable in identifying appropriate patients to refer for screening. METHODS: We conducted a survey of PCPs (n = 63) at a large urban university hospital. The survey consisted of eight questions regarding risk factors, screening recommendations and physician comfort in identifying appropriate patients for BE screening. RESULTS: Collectively, PCPs scored 60%, suggesting a significant lack of knowledge regarding BE, with only 13% of participants answering all questions correctly. In regards to identifying risk factors, only 25% answered correctly. 41% of respondents indicated they are comfortable identifying appropriate patients for screening. Comfortability was assessed on a scale of 1-5, with 1 being not comfortable at all. The average response was 3.02, reflecting neutrality in physician comfort. CONCLUSION: Our survey found that knowledge of risk factors among PCPs may be inadequate. Additionally, PCPs acknowledge they are not comfortable identifying appropriate patients for screening. This may stem from not being familiar with known risk factors or not being up to date with screening guidelines. Those in practice longer said they are more comfortable, however were not more knowledgeable in risk factors and screening guidelines, indicating that increased education is necessary throughout a physician's career. 1. Dulai, Gareth S., et al. "Preoperative prevalence of Barrett's esophagus in esophageal adenocarcinoma: a systematic review." Gastroenterology (2002): 26-33.