Abstract

Introduction
Endoscopic surveillance of Barrett’s oesophagus is recommended by many national societies to detect progression to adenocarcinoma at an earlier stage.
Our aim was to audit Aneurin Bevan Health Board (ABHB) compliance with the 2005 British Society of Gastroenterology (BSG) guidelines for the diagnosis and management of Barrett’s columnar-lined oesophagus.


Methods
Aneurin Bevan Health Board electronic prospective histopathological database was searched to identify all cases coded as Barrett’s oesophagus (BO) during the period from 2005 to 2011. Endoscopy reports of all patients were matched with histology reports. A retrospective registry was then constructed including demographics, clinico-pathological features, modes and rates of follow-up, pathological progression and incident cancer rate during the study period.


Results
A total of 773 cases were coded as BO during the period 2005 to 2011. Interrogation of all records confirmed 620 cases to be worthy of inclusion excluding 153 cases due to inadequate data or incorrect coding. The 620 cohort of patients consisted of 406 males and 214 females with a median age of 65 years (range 20 to 97years). BO histological confirmation was attained in 592/620 cases at index endoscopy and during a follow-up endoscopy in 28/620 cases. Intestinal metaplasia was reported in 459/620 cases. Dysplasia was diagnosed in 58/620 cases at index endoscopy; 16/620 of these index cases were reported as indefinite for dysplasia, 32/620 were low grade dysplasia and 10/620 cases were classified as high grade dysplasia. 233/620 (37.6%) patients had on average one follow-up and 100/620 (16.1%) had two or more follow ups during the study period.


Conclusion
Compliance with BSG follow-up recommendations and other practise parameters is poor. We recommend a formal surveillance programme with dedicated endoscopy lists to improve compliance and permit a meaningful assessment of the clinical and cost effectiveness of such strategy.


Disclosure of Interest
None Declared