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Screening and Barrett's Esophagus

David E. Langdon, MD
Arch Intern Med. 1997;157(10):1139. doi:10.1001/archinte.1997.00440310105011.
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In their excellent review, "Clinical Implications of Barrett's Esophagus,"1 Crooks and Lichtenstein mention the screening frequency in the flow diagram, "biopsy every 1-2 y," and totally ignore the critical concerns of cost. Many gastroenterologists favor yearly screening. National seminar discussants, although data are scant, often lump screening, the more common short-segment variety, with the traditional long-segment Barrett's, thereby greatly increasing the numbers. However, Provenzale et al2 modeled the patient and cost issues. Screening just every 4 years cost $276 000 per additional "quality-of-life year" gained.2 Yearly screening was nearly off the scale! Crooks and Lichtenstein cited the advantages of "mapping" using individual biopsy specimens from defined sites.1 Outside the academic world, processing charges are à la carte per bottle, although professional fees may reach a cap. Individualizing multiple biopsy specimens can add more than $1000. The time, risks, and facility charges of the endoscopy also increase.


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