If you’re a patient suffering from gastroesophageal reflux disease (GERD) wondering whether or not an endoscopy is in your future to screen for esophageal cancer, the answer may actually be no.
According to new guidelines published in Annals of Internal Medicine, the journal of the American College of Physicians, only GERD patients who have failed to respond to treatment and who display severe symptoms associated with esophageal cancer may need to undergo an upper endoscopy.
Furthermore, as Susan Perry of MinnPost points out, there isn’t sufficient evidence that routine use of an upper endoscopy can lower the risk of GERD patients dying from esophageal cancer. But there is evidence that overuse of the procedure may be contributing to rising health care costs.
According to Perry:
“The authors of ACP’s guidelines quite bluntly cite financial incentives, along with malpractice concerns and patient expectations, as a key factor in the overuse of upper endoscopies. Given how much money is involved, there’s likely to be some considerable physician backlash to the new guidelines.”
But in an accompanying editorial, University of Minnesota adjunct professor of John I. Allen, M.D., takes the opposite approach, stressing that, for the good of their patients, physicians should already be choosing wisely on when to order an upper endoscopy. He cites a patient diagnosed with GERD who underwent an endoscopy that turned out normal, but who was told she had “impending Barrett’s esophagus” and was recommended for another endoscopy two years later, and again two years after that. Later, she arrived to Allen who, after reviewing her records, told her she was not at increased risk for esophageal cancer and didn’t need another endoscopy.
“Closer examination of my patient highlights the difficulties we face as we try to alter our current health care delivery system, where volume drives payment, reimbursements occur in independent silos, decisions are often made without informed patient input and health outcomes are dissociated economically from specific services rendered.”
For patients battling GERD, the new guidelines recommend that endoscopy be reserved for patients with symptom-defined heartburn plus either alarm symptoms, persistent symptoms despite a trial of maximum acid-reducing medical therapy, severe erosive esophagitis after 2 months of medical treatment, or a history of symptomatic esophageal stricture. The committee also concludes that endoscopy may be considered as a screen for Barrett or esophageal cancer in men with GERD aged 50 years or older and for Barrett surveillance at more appropriate intervals.