OGBN P23 Diagnosing and mapping Barrett's oesophagus: a need to be better

Abstract

Abstract Background The diagnosis of Barrett's oesophagus is made by endoscopic assessment of the oesophageal epithelium and histopathological confirmation of intestinal metaplasia on oesophageal biopsies. There are clear standards for the diagnosis of Barrett's oesophagus described by the British Society of Gastroenterologists (BSG). It is vital to maintain these standards to ensure accuracy of diagnosis (to prevent both over-diagnosis and under-diagnosis) and to ensure that conversion to dysplasia or neoplasia is not missed. This study aimed to assess the quality of Barrett's surveillance at our institution and implement changes in our service to improve diagnosis. Methods All patients who were due to have Barrett's surveillance endoscopy in 2022 were identified from our electronic hospital waiting lists. Initial endoscopy reports, where the Barrett's was diagnosed, were obtained and assessed for quality of adherence to BSG standards, such as image capture, number of biopsies, recording of Prague classification, use of high-definition screens and use of adjuncts (such as infacol or acetic acid). Histopathological reports were obtained and assessed for correlation with endoscopic findings. Results 192 patients were identified for this study. All had Barrett's oesophagus diagnosed between 2016 and 2020, either on endoscopic grounds, histopathological suggestion of intestinal metaplasia, or both. A total of 29 different endoscopists (including consultant gastroenterologists, surgeons, trainees, nurse endoscopists and endoscopists from outsourcing companies) had performed the primary diagnostic scope in this cohort. 55 patients (29%) did not have any images captured and recorded on their endoscopy report. 36 patients (19%) did not have a Prague classification recorded. Only 127 patients (66%) had intestinal metaplasia on biopsies. p53 status was not recorded in any case. Conclusions This study highlights several deficiencies in the current practice of diagnosis of Barrett's oesophagus and these findings may be replicated in other units. These data have been used to develop a wide-ranging quality improvement programme for Barrett's surveillance, including dedicated Barrett's lists shared amongst a small number of experienced endoscopists, use of a high resolution scope and camera system, image capture and appropriate 'pointing' of procedures to allow enough time for accurate mapping and use of endoscopic adjuncts.