BACKGROUND AND AIMS
Barrett’s oesophagus (BO) has a premalignant potential. Several guidelines to optimise surveillance and early detection of dysplasia were produced.1-3 A previous audit in the authors’ hospital revealed significant departure from the guidelines. Dedicated lists and educational intervention were suggested to improve the quality of surveillance.4,5 The authors aimed to evaluate the compliance of BO surveillance with the published guidelines in their centre between 1st February 2021 and 31st March 2022 after the introduction of dedicated lists with longer time slots of 30 minutes.
MATERIALS AND METHODS
A retrospective database search was performed for the word “Barrett” using the built-in audit tool of Infoflex v.5 reporting system and cross-referenced with the histopathology database. Surveillance details were added to an Excel (Microsoft, Redmond, Washington, USA) spreadsheet against criteria extracted from both the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Results were compared with the previous audit.
RESULTS
During the study period, 204 BO reports were found. The number of patients undergoing surveillance was 112/204 (55%) and 92/204 (45%) were newly diagnosed. In the surveillance group, 80 were males (71%) and 32 were females (29%). The age range was 41–83 years, with a mean age of 62 years. Barrett’s segment was described according to Prague criteria in 111/112 (99% compared to 89% in the previous audit). Thirty-one were short segment (i.e., <3 cm) and 81 were long segment (≥3 cm). Seattle protocol of biopsies was followed in 104/112 (93% compared with 70% previously) and chromoendoscopy (narrow-band imaging and 2% acetic acid spray) was performed in 66/112 (59% compared with 33% in previous audit). Inspection time was recorded in seven out of 112 (6% versus 2.5% in previous audit). Correct surveillance interval from last examination occurred in 103 (92% as opposed to 88% in previous audit).
Intestinal metaplasia was not confirmed in six patients. All were discharged from surveillance as this was the second endoscopy with negative intestinal metaplasia in compliance with the guidelines. Dysplasia was detected in 10 cases (nine low-grade and one high-grade). Seven low-grade dysplasias and one high-grade dysplasia were appropriately followed up and managed. A lesion within the Barrett’s was seen in two cases. Both had distance from incisors recorded and targeted biopsies taken, but no Paris classification or position was described according to the clock face.
There was also a discrepancy in the length of Barrett measured between the initial and follow-up endoscopies in 40/112 cases (35%), but a significant difference affecting the surveillance interval was observed in seven cases only (6%).
CONCLUSION
Despite significant improvements from the previous audit, namely the use of Seattle protocol and chromoendoscopy, dedicated lists have not achieved >90% in all parameters that was intended. There is still more that needs to be done to optimise surveillance in relation to recording the BO inspection time, accurate measurement of the BO length, and lesion description. The authors introduced mandatory fields in the endoscopy reporting that would be triggered once BO surveillance has been chosen, to improve the above with further re-audit.
