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• W4316087029 abstract "Introduction: Barrett’s esophagus (BE) is the only known precursor lesion of esophageal adenocarcinoma (EAC), a malignancy with poor 5-year survival. Screening for BE is endorsed in those with risk factors. Assessing BE/EAC risk remains challenging. The Kunzmann score is a tool to identify patients at risk of BE/EAC. We assessed the ability of this tool to predict BE/EAC risk 5 years prior to BE/EAC diagnosis in a large population-based database. Methods: The Rochester Epidemiology Project contains medical records of over 90% of SE Minnesota residents since 1977. Utilizing appropriate ICD-9 and 10 codes, we identified all BE/EAC patients from 1977-2020. Endoscopic evidence of at least 1 cm of salmon colored mucosa in the tubular esophagus and presence of intestinal metaplasia on endoscopic biopsies were assessed to confirm BE diagnosis. We also identified non-BE/EAC controls, and endoscopic reports were reviewed to exclude BE/EAC in these patients. The Kunzmann score is a composite score based on age, gender, smoking history, presence of esophageal conditions (such as heartburn), and BMI. It has previously been reported to have a sensitivity and specificity for EAC of 77.5% and 70.5%, respectively, utilizing a cut off score of 8. We compared risk prediction scores between BE patients and non-BE controls at datapoints obtained 5 (±1) years prior to BE diagnosis. (Table) Results: Data to calculate the Kunzmann score were abstracted from 916 cases (684 BE,232 EAC) 5 years prior to diagnosis and from 100 endoscopy negative controls. The mean Kunzmann score 5 years prior to diagnosis was significantly higher in the EAC group (10.6; SD: 2.0) compared to those with baseline BE (9.7; SD: 2.5) and controls (10.2; SD: 2.5; p < 0.01). Furthermore, the percentage of patients with a Kunzmann score greater than 8 at 5 years prior to diagnosis was highest in the EAC group (90.9%) compared to the baseline BE (78.8%) and control (83.0%; p< 0.01) groups. Utilizing a cut-off score of 8, the Kunzmann score at 5-years prior to diagnosis demonstrated a sensitivity of 84.0% and specificity of 18.1% for the diagnosis of BE/EAC, and demonstrated a sensitivity of 79.5% and specificity of 9.1% for the diagnosis of EAC alone. Conclusion: In this large population-based database, the Kunzmann score demonstrated reasonable sensitivity but low specificity to predict BE/EAC at 5 years prior to diagnosis. Its utility for predicting BE/EAC risk needs to be further evaluated. Table 1. - Baseline characteristics and Distributions of Kunzmann Score in BE cases, EAC cases and Endoscopy Negative Controls in a Population Based Cohort BE (N=684) EAC (N=232) Endoscopy Negative Controls (N=100) Mean (SD) age 61.8 (13.7) 65.6 (11.7)* 65.9 (13.8) < 0.01 Male, N (%) 490 (71.6%) 201 (86.6%) 66 (66.0%) < 0.01 White, N (%) 620 (90.6%) 211 (90.9%) 96 (96.0%) 0.5 Mean (SD) BMI 30.3 (6.0) 30.3 (6.2) 30.3 (6.1) 1.0 Never smokers, N (%) 248 (36.5%) 61 (26.3%)* 40 (40.0%) 0.04 Baseline BE grade, N (%) NDBE 570 (83.3%) - - - LGD 37 (5.4%) - - - IND 52 (7.6%) - - - HGD 25 (3.7%) - - - EAC - 232 (100.0%) - - Baseline mean (SD) BE length, cm 4.0 (3.3) 5.4 (3.1)* - Presence of Hiatal hernia, N (%) 459 (67.1%) 68 (29.3%) 55 (55.0%) < 0.01 History of GERD, N (%) 304 (44.4%) 85 (50.3%) 100 (100.0%) - Mean (SD) Kunzmann Score 9.7 (2.5) 10.6 (2.0)* 10.0 (2.4) < 0.01 Kunzmann score greater than 8 539 (78.8%) 211 (90.9%) 84 (84.0%) < 0.01" @default.
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• W4316087029 date "2022-10-01" @default.
• W4316087029 modified "2023-10-18" @default.
• W4316087029 title "S450 Assessment of the Accuracy of a Clinical Risk Prediction (Kunzmann) Score 5 Years Prior to Barrett’s Esophagus and Esophageal Adenocarcinoma Diagnosis: Results From a Large Population-Based Database" @default.
• W4316087029 doi "https://doi.org/10.14309/01.ajg.0000858440.05469.b7" @default.
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