PTH-023 Barrett’s surveillance in a district general hospital: do we follow guidelines for non-dysplastic barrett’s?

Introduction BSG 2013 guidelines for diagnosis and management of Barrett’s oesophagus (BE) recommend surveillance intervals based on the length of BE, histology, and presence of intestinal metaplasia. Practice for BE surveillance varies nationally. East and North Hertfordshire NHS Trust is a district general hospital with a population of approx. 6 00 000. Since the 2013 guidelines most BE surveillance is done by 2 consultants and a specialist nurse. Methods A retrospective review of all gastroscopies performed for the indication of BE surveillance from 1/1/16 – 31/12/16. These were audited against BSG 2013 guidelines specifically looking at use of Prague criteria (PC), histology and selection of surveillance intervals. All endoscopies were performed using high definition video-endoscopes. Results 207 OGDs for BE surveillance were reviewed (median age 68 [29–90], 75% males). 144 (70%) recorded BE length using the PC. 23 (11%) had either no or minimal Barrett’s ( Analysis of surveillance intervals was performed only on the 144 OGDs where length of BE was documented fully using PC. Amongst these were 17 cases of dysplasia (12%: 6 indefinite for dysplasia, 7 low grade dysplasia, 4 high grade dysplasia). The remaining 127 cases (88%) were non-dysplastic. Distribution of length of BE is displayed in figure 1. Of the non-dysplastic cases, 46 (36%) had a BE length of Conclusions Whilst we reported 70% of our BE length using PC, a measure now recommended as a quality standard, a further 19% could have been reported this way. Our data show that only 10% (13) of our 127 non-dysplastic BE cases had an incorrect surveillance interval chosen, less than the figures suggested by JAG who estimate that 30% of patients undergo surveillance at incorrect intervals or where not indicated at all. Of the 207 OGDs analysed, 135 (65%) were carried out by one of our 2 consultants with specialist interest in BE or our BE specialist nurse endoscopist. We therefore support the advice that BE surveillance should be performed on dedicated lists in order to improve endoscopic quality reporting and choice of correct surveillance interval.