Current practice in surveillance strategy for patients with Barrett's oesophagus in the UK
Mandal, A and Playford, RJ and Wicks, AC, Current practice in surveillance strategy for patients with Barrett's oesophagus in the UK, Alimentary Pharmacology and Therapeutics, 17, (10) pp. 1319-1324. ISSN 0269-2813 (2003) [Refereed Article]
Background: Many guidelines exist regarding the surveillance of patients with Barrett's oesophagus. There are limited data, however, with regard to whether practitioners follow these guidelines. Methods: We assessed current surveillance practice amongst members of the British Society of Gastroenterology using a simple 11-question anonymized survey, mailed to 300 randomly selected members from the British Society of Gastroenterology Handbook. Results: Two hundred and three of the 300 (68%) responded, 76% considering that surveillance was worthwhile. In those who considered surveillance to be worthwhile, 83% used sub-selection based on age, the length of Barrett's oesophagus or the presence of ulcer or stricture. Patients with Barrett's oesophagus of < 3 cm (short-segment) were considered to be inappropriate for surveillance by 62%. Forty-one per cent reported following the 'advised' recommendations of four-quadrant biopsies every 2 cm. whereas 44% followed a 'random and suspicious areas only' protocol. Marked variation was reported in the re-endoscope interval for both low- and high-grade dysplasia. Only 55% reported that two experienced pathologists reviewed all biopsies showing high-grade dysplasia. Conclusions: Despite the existence of multiple guidelines for Barrett's surveillance, clinical practice varies widely in the UK. This may be due to a lack of knowledge or because gastroenterologists remain unconvinced by the quality of the current evidence of its value. These results have implications for studies attempting to collate data from multiple centres.