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

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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.