Introduction Barrett’s oesophagus is a premalignant condition and patients with BO undergo surveillance to detect early cancerous changes. Our aim is to assess the effectiveness of endoscopic surveillance in detecting progression to High-Grade Dysplasia (HGD) or Oesophageal Adenocarcinoma (OAC).
Methods All BO cases coded in our histopathology database as dysplastic BO during the period from 2005 to 2015 were identified. The documented endoscopy reports were matched with histopathology reports. A retrospective database was then constructed including demographics, pathological features, modes and rates of follow-up and pathological progression. Our surveillance practice was also audited against the 2013 BSG guidance.
Results A total of 73 cases were identified as dysplastic BO; the cohort consisted of 55 males and 18 females. (Mean age: 70.1 years, range: from 51.4 to 88.4 years). 47/73 (64%) had hiatus hernia. Intestinal metaplasia was reported in 71/73 cases. 14/73 cases (19%) progressed to HGD or OAC. Five patients offered oesophagectomy, while the others had surveillance (3), endoscopic mucosal resection (3) or chemo/radiotherapy (3). 4/14 cases were noted to have either prevalent HGD/OAC (3) or interval OAC (1) and hence excluded from the audit. Five cases did not have any follow up either because of the patient’s noncompliance (2) or the endoscopists’ recommendation (3). 64 (88%) cases had complete data and constituted the cohort for assessment of compliance with BSG guidance. Mean follow up was 4.67 years. The total number of endoscopies performed during this period was 250. 65.2% (163/250) of endoscopies were compliant with BSG follow up protocol. Only 18/130 endoscopies (13.8%) provided both C and M measurements of Prague measurement. Average BO length based on 113 endoscopies was 5.3 cm. The mean expected number of biopsies was 11.0 while the actual number of biopsies taken was 7.3 (66.1%). There was some discordance between the number of biopsies mentioned by endoscopists and the number of biopsies counted by pathologists in 72 available endoscopic and pathological data. Overall compliance with BSG protocol in terms of follow up, Prague criteria and sampling count was 48.4% in total.
Conclusion The surveillance program detected progression to HGD or OAC in 10 cases (14.5%). Compliance with BSG protocol in terms of follow up, Prague criteria and sampling count was noted in 48.4%. Further adherence with the BSG guidelines is needed to improve the surveillance program.
Disclosure of Interest None Declared
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