Implementation of Provider-Facing Interventions to Increase Uptake of Endoscopic Screening for Esophageal Adenocarcinoma

BACKGROUND AND AIMS: Screening uptake among individuals at high-risk for esophageal adenocarcinoma and gastric cardia adenocarcinoma remains poor. We conducted a pilot study to evaluate the real-world implementation of 2 approaches for endoscopic screening uptake in high-risk individuals identified by an automated risk assessment tool, with the aim of identifying facilitators, barriers, and implementation gaps. METHODS: Pilot 1 involved notifying primary care provider (PCPs) of patients at high risk and due for colorectal cancer screening. Pilot 2 used nurse outreach to offer esophagogastroduodenoscopy (EGD) to high-risk patients scheduling a screening colonoscopy. The primary outcome was feasibility - EGD ordered among eligible patients. Secondary outcomes included EGD completion and acceptability, assessed through semistructured interviews with patients, PCPs, gastroenterologists, and facility leadership. RESULTS: In Pilot 1, PCPs were notified of 97 high-risk patients; EGDs were ordered in 28 (29%) and completed in 15 (54% of ordered). If colorectal cancer screening was ordered, PCPs were more likely to discuss esophageal adenocarcinoma/gastric cardia adenocarcinoma risk (69% vs 36%, P < .01). EGD was more likely ordered if colonoscopy was ordered vs fecal testing (88% vs 39%, P < .01). In Pilot 2, 9 of 86 eligible patients were contacted; EGDs ordered for 6 (7%) and completed in all 6 (100% of ordered). Providers valued decision support tools and automatic electronic health record alerts, but cited lack of supporting evidence, guideline recommendations, and clinic time as barriers. CONCLUSION: Both provider notifications and nurse outreach demonstrated high acceptability and completion but limited feasibility for increasing EGD orders due to provider and system-level barriers, highlighting implementation gaps and targets for guideline and workflow integration.