Screening or surveillance for Barrett’s?

Deciding how to manage our Barrett’s patients is a headache for many gastroenterologists. Barrett’s oesophagus is common, cancer risk is reportedly high and surveillance for dysplasia seems no less feasible than it is in ulcerative colitis. Nevertheless the difficulties are all too obvious.

In the absence of randomised trials decision analyses are perhaps our best guide. Several have tackled Barrett’s screening and surveillance and this one by Inadomi et al is the latest and arguably the most robust. They modelled the cost effectiveness of screening men aged 50 with reflux symptoms. Screening followed by surveillance in patients with Barrett’s and dysplasia would cost $10 400 per quality adjusted life year (QALY) while surveillance for those with Barrett’s but no dysplasia would cost an additional $596 000 per QALY. In addition performing oesophagectomy only when cancer was present cost less and yielded more QALYs than oesophagectomy for high grade dysplasia as well as cancer. Their conclusion is that initial screening to detect Barrett’s and dysplasia is probably cost effective but subsequent surveillance in the absence of dysplasia, even 5 yearly, is not.

A dip into Ascitic fluid!

Spontaneous bacterial peritonitis (SBP) in patients with cirrhosis …