Surveillance of Barrett's esophagus: a need for guidelines?
Barrett's esophagus carries a 10-15% lifetime risk of malignant change, and dysplasia may be an early indication of such transformation. Endoscopic surveillance is widely practised but guidelines have not been established. A questionnaire regarding surveillance protocols was sent to all consultants in the Trent Region performing endoscopy (n = 79), of whom 58 (73%) replied. Surveillance is performed by 52 clinicians (90%), but the interval varies between 1 and 3 years. Routine biopsies are only taken by 38 (65%), of which 74% are taken randomly. Detection of low-grade dysplasia would lead 32 (62%) to reduce the surveillance interval. For high-grade dysplasia, a reduced surveillance interval or surgery is advocated by 36 (69%) and 13 (25%), respectively. Most clinicians (74%) discontinue surveillance at age 70 or 75. Surveillance of Barrett's esophagus is variable, especially in the presence of dysplasia. No surveillance guidelines are available, but most respondents (79%) believe these would help.
Ackroyd
R
R
Department of Surgery, Royal Hallamshire Hospital, Sheffield, UK.
Wakefield
S E
SE
Williams
J L
JL
Stoddard
C J
CJ
Reed
M W
MW
D000230:Adenocarcinoma / Q000453:epidemiology / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis* / Q000453:epidemiology; D001707:Biopsy, Needle; D003625:Data Collection; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000453:epidemiology; D012307:Risk Factors; D006113:United Kingdom