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PTU-157 Reviewing The Standardised Approach – An Audit of 250 Barrett’s Surveillance Cases
  1. R Das,
  2. A Mandal,
  3. D Leonard,
  4. S Nawaz
  1. Gastroenterology, Lincoln County Hospital, Lincoln, UK

Abstract

Introduction Barrett’s oesophagus (BO) confers a relative risk of 11.3 over that of the general population for the development of oesophageal adenocarcinoma.(Hyid 2011) The endoscopic surveillance of BO remains the only modality for the detection of emergent dysplasia, which has been established as a premalignant development.(Flejou 2005) The 2013 BSG Guideline on BO explicitly suggests the use of a ‘minimum dataset’ in order to standardise BO reporting and for the audit of this practice in order to ensure high quality BO management.(Fitzgerald et al. 2013)

Methods The advised minimum dataset includes the standardised ‘Prague classification’ and hiatus hernia reporting. We report the audit of standardised reporting in 250 patients – a volume that represents roughly forty percent of the annual Barrett’s surveillance load in between two large District General Hospitals in Lincolnshire(UK).

Results Adherence to the ‘Prague Classification’ was demonstrated in 56% of reports (141 of 250). The Gastro-oesophageal-junction was only documented as being noted in 44% (109 of 250), with length of hiatus hernias being documented in 61% (105 of 173).

Nurse endoscopists and doctors utilised the Prague classification equally – 48% and 52% respectively. Nurse endoscopists reported hiatus hernia length in only 38% of cases, with doctor (any grade) reporting at 62%. Interestingly overall only 32% of reports made any mention of proton pump inhibitor (PPI) use or advised of PPI initiation.

Of the total (n = 250) 7 cases of dysplasia and 4 cases of adenocarcinoma were detected. The single detected high-grade dysplasia was referred appropriately for UGI multidisciplinary team input. Two cases of indefinite dysplasia were noted, and repeat endoscopy planned within a 6 month period. The overall finding of 11 cases (4.4%) of dysplasia or malignancy was in keeping with expected detection rates as reported by recent meta-analyses.(Qiao 2015)

Conclusion While dysplasia and adenocarcinoma detection rates are within acceptable ranges, improved adherence to the ‘minimum dataset’ is needed. We have recommended serial clinical update sessions for endoscopists and planned further re-audit.

References 1 Pietro M, Ragunath K, et al. British society of gastroenterology guidelines on the diagnosis and management of Barrett’s Oesophagus. Gut. 2013;10:1136–40.

2 Flejou JF. Barrett’s oesophagus: from metaplasia to dysplasia and cancer. Gut. 2005;54:1–12.

3 Hvid-Jensen F, Pedersen L, Drewes A, et al. Incidence of adenocarcinoma among patients with Barrett’s oesophagus. N Engl J Medi. 2011. 365: 1375–83.

4 Qiao Y, Hyder A, et al. Surveillance in patients with Barrett’s Oesophagus for early detection of Esophageal Adenocarcinoma: A systematic review. Gastroenterology. 2015. 131:1038–1040.

Disclosure of Interest None Declared

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