P193 A dedicated Barrett's oesophagus endoscopy service improves dysplasia detection and adherence to guidelines: 5-year experience. (19th June 2022)

• Record Type: Journal Article
• Authors: Ratcliffe, Elizabeth; Britton, James; Yalamanchili, Harika; Rostami, Izabela; Hasnain Nadir, Syed Mujtaba; Korani, Mohamed; Eruchie, Ikedi; Awais, Muhammad; Prasad, Neeraj; McLaughlin, John; Hamdy, Shaheen; Ang, Yeng
• Is Part Of: Gut. Volume 71(2022)Supplement 1
• Page Start: A134
• Page End: A134
• Publication Date: 2022-06-19
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2022-BSG.247
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: Barrett's oesophagus (BO) neoplasia surveillance guidelines can be poorly adhered to with endoscopists routinely under-biopsying longer segments. Dedicated endoscopy services run by those trained in BO may offer better outcomes. Methods: This is a 5-year retrospective audit of a dedicated BO service at Wrightington Wigan and Leigh NHS trust compared with endoscopies performed on non-dedicated slots. Statistical significance between groups was calculated with Chi squared on SPSS. Results: 1023 Barrett's surveillance procedures were included (733 patients). 658 (64%) endoscopies were on a dedicated BO list vs 365(36%) on non-dedicated. There was no difference in male to female ratio (p=0.235), median age (67 years (26-91 dedicated) vs 67years (32-91)) or median Prague M length (3cms (0-17dedicated) vs 3cms (0-15)). Dysplasia detection rate (DDR) was significantly higher in the dedicated cohort 9% (59/651) vs 3.7% (13/351) p=0.002. Significance was sustained when cases with known prior dysplasia were excluded: 6.1% 38/622 versus 3.2% 11/347 (p=0.045). Narrow band imaging (NBI) (p=<0.001) and acetic acid (p=<0.001) were more frequently used on the dedicated list. Targeted biopsies were more frequently obtained on the dedicated cohort (p=<0.001). Guideline adherence was significantly better with dedicated endoscopy ( table 1 ). Across all cases factors associated with improved DDR included visible lesion documentation (p=<0.001), use of targeted biopsies (p=<0.001), acetic acid use (DDR 14.4% vs 5.6% p=<0.001) and use of narrow band imaging (DDR 10% vs 3% p=0.001). There was no association with documented Seattle protocol adherence (p=0.074) Conclusions: A dedicated Barrett's service shows improved dysplasia detection and guideline adherence. As these data show lesion recognition, acetic acid and NBI use may improve outcomes, it is imperative surveillance is performed by adequately trained clinicians, skilled in neoplasia detection, across the tertiary and non-tertiary setting.