Post Endoscopy Barrett’s Neoplasia (PEBN) After A Negative Index Endoscopy: A Systematic Review & Proposal For Definitions and Performance Measures in Endoscopy

Background and aims: A high rate of neoplasia (high grade dysplasia; HGD and esophageal adenocarcinoma; EAC) has been reported in Barrett’s Esophagus at index endoscopy but precise rates of post endoscopy Barrett’s neoplasia (PEBN) are unknown. Methods: Systematic review and meta-analysis was performed examining electronic databases (inception to October 2021) for studies reporting PEBN. Consistent with definitions of Post Colonoscopy Colorectal Cancer as proposed by the World Endoscopy Organization, we defined neoplasia(HGD/EAC) detected at index endoscopy and/or within 6 months of a negative index endoscopy as “prevalent” neoplasia; those detected after 6 months of a negative index endoscopy and prior to next surveillance interval(i.e. 3 years) as PEBN or “interval” neoplasia, and those detected after 36 months of a negative index endoscopy as “incident” neoplasia. Pooled incidence rates and proportion relative to total neoplasia were analyzed. Results: 11 studies (n=59,795, age:62.3±3.3 years, 61%males) met inclusion criteria. The pooled incidence rates were: prevalent neoplasia 4.5% (95%confidence interval: 2.2-8.9) at baseline and additional 0.3%(0.1-0.7) within first 6 months, PEBN 0.52%(0.48-0.58) and incident neoplasia: 1.41%(0.93-2.14). At 3 years from index endoscopy, PEBN accounted for 3% while prevalent neoplasia accounted for 97% of total Barrett’s neoplasia. Conclusion: Neoplasia detected at or within 6 months of index endoscopy account for most of the Barrett’s neoplasia(>90%). Post-Endoscopy Barrett’s Neoplasia account for ~3% of cases and can be used for validation in future. This highlights the importance of a high-quality index endoscopy in Barrett’s Esophagus and the need to establish quality benchmarks to measure endoscopists’ performance.