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Dedicated service improves the accuracy of Barrett’s oesophagus surveillance: a prospective comparative cohort study
  1. James Britton1,2,
  2. Kelly Chatten3,
  3. Tom Riley4,
  4. Richard R Keld1,
  5. Shaheen Hamdy2,4,
  6. John McLaughlin2,4,
  7. Yeng Ang2,4
  1. 1Department of Gastroenterology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
  2. 2Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
  3. 3Department of Gastroenterology, Stockport NHS Foundation Trust, Stockport, Stockport, UK
  4. 4Department of Gastroenterology, Salford Royal NHS Foundation Trust, Salford, UK
  1. Correspondence to Dr Yeng Ang, Department of Gastroenterology, Salford Royal NHS Foundation Trust, Salford M6 8HD, UK; Yeng.Ang{at}srft.nhs.uk

Abstract

Objectives Standards for Barrett’s oesophagus (BO) surveillance in the UK are outlined in the British Society of Gastroenterology (BSG) guidelines. This study aimed to assess the quality of current surveillance delivery compared with a dedicated service.

Design All patients undergoing BO surveillance between January 2016 and July 2017 at a single National Health Service district general hospital were included. Patients had their endoscopy routed to a dedicated BO endoscopy list or a generic service list. Prospective data were analysed against the BSG guidelines and also compared with each patient’s prior surveillance endoscopy.

Results 361 patients were scheduled for surveillance of which 217 attended the dedicated list, 78 attended the non-dedicated list and 66 did not have their endoscopy. The dedicated list adhered more closely to the BSG guidelines when compared with the non-dedicated and prior endoscopy, respectively; Prague classification (100% vs 87.3% vs 82.5%, p<0.0001), hiatus hernia delineation (100% vs 64.8% vs 63.3%, p<0.0001), location and number of biopsies recorded (99.5% vs 5.6% vs 6.9%, p<0.0001), Seattle protocol adherence (72% vs 42% vs 50%, p<0.0001) and surveillance interval adherence (dedicated 100% vs prior endoscopy 75%, p<0.0001). Histology results from the dedicated and non-dedicated list cohorts revealed similar rates of intestinal metaplasia (79.8% vs 73.1%, p=0.12) and dysplasia/oesophageal adenocarcinoma (4.3% vs 2.6%, p=0.41).

Conclusions The post-BSG guideline era of BO surveillance remains suboptimal in this UK hospital setting. A dedicated service appears to improve the accuracy and consistency of surveillance care, although the clinical significance of this remains to be determined.

  • barrett’s oesophagus
  • endoscopy
  • barrett’s carcinoma

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Footnotes

  • Contributors All authors significantly contributed to this work. The concept and design of this study was instigated by YA, RRK, JB, JM and SH. Data were collected by TR and JB. KC led the data analysis. JB and KC drafted the initial manuscript. All authors had a role in the writing and revision of the manuscript prior to submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note The abstract has been accepted for a poster presentation at the BSG conference in June 2018.

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