ThTP2.2 Correlation between conventional endoscopic and histopathological diagnosis of Barrett’s oesophagus

Abstract

Abstract Introduction The diagnosis of Barrett’s oesophagus is currently made with a combination of endoscopic appearances and presence of intestinal metaplasia (IM) on oesophageal biopsies. There have been minimum endoscopy and pathology reporting standards proposed by the British Society of Gastroenterologists and these include the use of high resolution endoscopy and the use of a comprehensive proforma for biopsies. This study compared the diagnosis of Barrett’s oesophagus between conventional endoscopy and histopathological analysis. Methods All patients who were due for surveillance endoscopy for Barrett’s oesophagus in 2022 were identified from a prospectively maintained waiting list. Endoscopy reports, biopsy results and outcomes were recorded. Correlation between endoscopic and histopathological results, with particular attention to the presence of intestinal metaplasia, was recorded. Results There were 192 patients identified for this study. All had endoscopic diagnosis of Barrett’s oesophagus (between 2016 and 2020) and were entered into a surveillance programme based on endoscopic diagnosis alone. 36 patients (19%) did not have a Prague classification (C and M grading) recorded on their primary endoscopy report and 55 patients (29%) did not have images available for review. None had HRE (all had conventional endoscopy). Only 127 patients (66%) had IM from original endoscopic biopsies and none had documentation of p53 status. Conclusion There was relatively poor compliance between current practice and gold-standard recommendations for endoscopy and pathology reporting. Just 66% of patients who had an endoscopic diagnosis of Barrett’s had IM on histopathology. These findings have implications for the accurate diagnosis and surveillance of Barrett’s oesophagus.