Introduction Oesophageal cancer is the fifth commonest cause of cancer death in the UK, and the incidence of adenocarcinoma is rising. Patients are often without symptoms until the tumour has grown to be inoperable, and the survival for this cancer remains poor. Early diagnosis is crucial to improve survival. Barrett’s oesophagus is the pre-cancerous lesion. The British Society of Gastroenterology (BSG) recommends regular surveillance depending on endoscopic and histological findings in order to identify oesophageal cancers at an earlier stage, therefore reducing mortality. There is evidence from previous studies on Barrett’s highlighting poor adherence to surveillance intervals, documentation of Barrett’s length as well as biopsy protocol. Pooling of Barrett’s patients on dedicated Barrett’s lists may help with better adherence to guidelines and may enhance detection of dysplasia with better outcomes for patients.
We aim to investigate whether a ‘dedicated’ Barrett’s surveillance list improved diagnosis and adherence to the BSG guidelines compared to more ‘ad-hoc’ surveillance on routine lists.
Methods This retrospective study analysed all patients undergoing endoscopy for Barrett’s surveillance at a North London hospital over a one-year period. We looked at documentation of the Prague Classification; adherence to the Seattle Protocol; exclusion of Barrett’s; biopsy results; and follow up.
Results 76 patients underwent surveillance, with 42 (55%) being performed during the 7 dedicated lists. The dedicated list excluded Barrett’s at endoscopy in 7 cases (9.2%) compared to only 1 (1.3%) in the routine list. Documentation was also significantly better with 85% of patients having the Prague Classification recorded, compared to only 32% in the routine group (p < 0.001). Also notable are the 7 patients in the routine group that had missing or erroneous information relating to the Seattle protocol. Adherence to the Seattle protocol was equally poor in both groups (dedicated = 49%, routine = 58%). There was no difference in histology results between the 2 groups. The follow up showed no correlation with the initial list, and frequently didn’t adhere to the BSG guidance.
Conclusion We provide evidence that dedicated lists improve both diagnosis and documentation in patients attending for Barrett’s surveillance. However, there still appears to be considerable scope for improving adherence to biopsy protocols and follow up plans. The proven benefit of dedicated endoscopic lists could be extended to dedicated follow up clinics to better subsequent management. Despite the stated shortcomings we recommend trials of dedicated lists on a wider scale to investigate whether this has a definite improvement in patient experience and management.
Disclosure of Interest None Declared
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