Improving surveillance for Barrett's oesophagus

Editor—The audit by Bampton et al highlights the practical problems encountered in the area of Barrett's oesophagus surveillance.¹ Our retrospective audit of 441 patients with Barrett's oesophagus in a university teaching hospital setting showed an alarmingly low compliance rate of 8.6%.² The main area of concern was that quadrantic biopsies were not taken in a large proportion of patients. Similar figures were seen in an audit in United States, where the compliance rates varied from 14% to 38% in a patient population from both teaching hospitals and community centres.³ As seen by Bampton et al, the prospective audit in our centre after guidelines were disseminated among endoscopists showed improved compliance only to 61%. The main reasons for lack of compliance continues to be the lack of dedicated endoscopy lists with extended time allocation and the ongoing debate between believers and non-believers of a surveillance strategy in Barrett's.

Figure 1.

Credit: DAVID MUSHER/SPL

A recent United Kingdom audit drew similar conclusions.⁴ Using a dedicated practitioner to flag up patients with Barrett's oesophagus, in conjunction with an adequate mechanism to evaluate usefulness of surveillance in individual patients as shown by the authors, seems to be the way forward. Although the cost implications of this approach are to be fully evaluated in the study, we agree that the costs may be offset by the potential savings from the reduction in the number of endoscopies done at inappropriate intervals. The value of chromoendoscopy and magnifying endoscopy in Barrett's oesophagus is still evolving. For the moment four quadrant biopsies remain key to a useful surveillance programme. The endoscopy governance meetings should focus on the much needed attention to the quality of Barrett's surveillance in individual centres.