Introduction Pan-colonic chromendoscopy (CE) is the gold standard for colitis surveillance. High quality procedures can reduce histology costs but require greater expertise but also additional time, estimated at 1 endoscopy slot per procedure. These, together with a competing rise in endoscopy demand have hindered the extra resource allocation for its widespread implementation. New BSG Barrett’s oesophagus (BO) surveillance guidelines have changed from previously biennial to lengthened surveillance intervals depending on an individual’s maximal BO length. The aim of this study was to model the reduction in endoscopic demand in our surveillance cohort after adoption of the new 2014 BSG guidelines and to determine whether sufficient capacity can be created to fully resource a dedicated CE service.
Method A retrospective analysis of all BO patients at York Hospital in 5 years between 2009 and 2013 was performed. The endoscopy and histology costs based on complete adherence to old BO guidelines were calculated on an annualised basis. Patients were split into 3 groups: those who did not have IM and could be discharged; those with short (<3 cm) BO were to be changed to 5 yearly surveillance; whilst those with long (≥3 cms) BO were changed to 3 yearly surveillance. The volume of endoscopy capacity created and the histology cost savings were calculated. Next, we looked at the number of conventional colitis surveillance colonoscopies performed per year over the same period of time with associated histology costs of serial biopsies.
Results Between 2009 and 2013, 453 BO surveillance patients, according to old BSG guidelines would require a mean of 227 OGDs per annum (p.a.). Based on current NHS tariffs and combined with associated histology costs, this would equate to £123,443 p.a. Seven (4.4%) patients had no evidence of IM and according to new BSG guidelines could potentially be discharged; 112 (24.7%) had short BO and 321 (70.9%) had long BO. Maximising their surveillance intervals would result in 128 surveillance OGDs and £69,940 in combined costs, thus freeing up a mean of 98 endoscopy slots p.a. with an overall annual cost saving of £53,503. Over the same period a mean of 92 surveillance colonoscopies were carried out for colitis with estimated histology costs of £18,400 p.a. Adopting Chromoendoscopy with targeted biopsies would reduce histology costs to £6,900, saving £11,500 per year.
Conclusion The provision of extra endoscopy capacity for CE can almost entirely be met by adoption of the new BSG BO surveillance guidelines. Furthermore, the combined approach yields an overall net histology cost saving of around £14,000 p.a. These cost analyses should support individual NHS Trust’s business cases for the widespread implementation of CE.
Disclosure of interest None Declared.
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