Elective surveillance gastroscopy in Barrett's oesophagus: a case study and review of the clinical endoscopist's role

Abstract

Barrett's oesophagus is characterised by the replacement of the stratified squamous epithelium that lines the distal oesophagus with red columnar epithelium. It is linked to gastro-oesophageal reflux disease (GORD) and increases the risk of oesophageal adenocarcinoma. Gold-standard surveillance is gastroscopy (oesophago-gastro-duodenoscopy), with measurement by mucosal observation according to the Prague Classification and histopathological biopsy to identify intestinal metaplasia. The American Society of Anesthesiologists (ASA) Classification helps assess a patient's risk of adverse events, including hypoxia, infection, bleeding or perforation. Patients are offered conscious sedation with intravenous midazolam under a patient group directive, which has its own risks. Preprocedural postal information and consultation ensures patients are sufficiently informed to give valid consent. A follow-up care plan is given to the patient on discharge. Clinical endoscopists can use the Calgary-Cambridge model and the SURETY communication models to deliver holistic patient-centred care. The clinical endoscopist's role in this pathway is examined in reference to British Society of Gastroenterology and international guidelines, research and a case study.