Surveillance of Barrett's columnar-lined oesophagus in the UK: endoscopic intervals and frequency of detection of dysplasia.
OBJECTIVE
Endoscopic surveillance of patients with columnar-lined oesophagus (CLO) may identify those with early adenocarcinoma (AC). The benefits of surveillance are unproven and there is little evidence to support recommendations for precise endoscopic intervals. We sought to examine surveillance practice for CLO in the UK and the impact of endoscopic intervals on detection of dysplastic disease.


METHODS
Eight hundred and seventeen patients with CLO, registered with the UK National Barrett's Oesophagus registry and undergoing surveillance were studied. Endoscopic intervals were calculated and frequency of detection of dysplastic disease analysed using chi2 test of association. Factors affecting surveillance intervals were analysed using multiple linear regression.


RESULTS
94.7% of patients with low-grade dysplasia (LGD), 95.0% with high-grade dysplasia (HGD) and 71.4% with AC were diagnosed on surveillance endoscopies. Mean endoscopic surveillance intervals varied between the centres from 1.07 to 1.63 years for nondysplastic CLO; 0.69-1.19 years for LGD, and 0.35-1.17 years for HGD; with overall mean surveillance intervals of 1.29, 1.01 and 0.44 years, respectively. When LGD was surveyed, significantly higher proportions of HGD/AC were detected at intervals of 3 months or less (P=0.013). Shorter endoscopic intervals were significantly associated with the presence of oesophageal strictures (P=0.002), ulcers (P=0.046), increasing patient age (P<0.001) and higher grade of dysplasia surveyed (P<0.001).


CONCLUSIONS
A variation in surveillance practice for CLO was observed throughout the UK. A large proportion of dysplastic disease is detected on specific surveillance endoscopies. Shorter endoscopic intervals for surveillance of LGD are associated with an increased detection of HGD/AC.
Ramus
James R
JR
UK National Barrett's Oesophagus Registry, Royal Free and University College Medical School, London, UK. jimramusuk@yahoo.co.uk
Gatenby
Piers A C
PA
Caygill
Christine P J
CP
Winslet
Marc C
MC
Watson
Anthony
A
D000230:Adenocarcinoma / Q000175:diagnosis*; D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis*; D018450:Disease Progression; D042241:Early Diagnosis; D004938:Esophageal Neoplasms / Q000175:diagnosis*; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D011230:Precancerous Conditions / Q000175:diagnosis*; D011364:Professional Practice; D012042:Registries; D013997:Time Factors; D006113:United Kingdom