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THE QUALITY AND YIELD OF DEDICATED ENDOSCOPY FOR BARRETT’S OESOPHAGUS IS HIGHER THAN THAT IN CONVENTIONAL SERVICE: A MULTICENTRE RETROSPECTIVE COMPARATIVE STUDY

Champika Gamakaranage 1, Elizabeth Ratcliffe 2, James Britton 2, Richard Keld 3, neeraj prasad 3, Mark Murgatroyd 4, Daniel Plant 5, Matthew Johnston 5, Jenni Marsh 3, Claudia Cipriano 6, Nasar Aslam 7, Vinay Sehgal 7, Anjan Dhar 8, Shaheen Hamdy 6, John McLaughlin 6, Yeng Ang 6

Affiliations

1 The University of Manchester, Manchester, United Kingdom|||Wrightington Wigan and Leigh Teaching Hospitals NHS FT, Wigan, United Kingdom

2 Northern Care Alliance NHS FT, Salford, United Kingdom

3 Wrightington Wigan and Leigh Teaching Hospitals NHS FT, Wigan, United Kingdom

4 Bolton NHS FT, Bolton, United Kingdom

5 County Durham and Darlington NHS FT, Darlington, United Kingdom

6 The University of Manchester, Manchester, United Kingdom|||Northern Care Alliance NHS FT, Salford, United Kingdom

7 University College London Hospital NHS FT, London, United Kingdom

8 County Durham and Darlington NHS FT, Darlington, United Kingdom|||Teeside University, Middlesbrough, United Kingdom

Summary

AI Generated

A multicentre UK retrospective study of 1303 Barrett's oesophagus surveillance procedures found that dedicated expert surveillance achieved a significantly higher dysplasia detection rate (8.5%) compared with conventional surveillance (2.6%), with better adherence to quality indicators and lower complication rates.

Dedicated surveillance detected dysplasia in 58 of 680 procedures (8.5%) versus 16 of 623 (2.6%) in conventional surveillance, a statistically significant difference (P<0.001).
All assessed quality indicators—including Prague classification, visible lesion documentation, Paris classification, Seattle protocol adherence, and inspection time—were significantly better in the dedicated service (P<0.001).
Regression analysis identified increasing age, male sex, visible lesion documentation, and Paris classification documentation as factors independently associated with higher dysplasia detection.
Dedicated surveillance used advanced imaging techniques (narrow band imaging and acetic acid chromoendoscopy) significantly more often and had a significantly lower complication rate (P=0.05).
The authors conclude that dedicated Barrett's surveillance services warrant prospective evaluation to assess impact on mortality, morbidity, and cost-effectiveness.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

A decade ago, endoscopic surveillance (ES) for Barrett’s oesophagus (BO) was recommended to improve the outcome of oesophageal adenocarcinoma through early recognition and prevention¹. The yield of ES to detect dysplasia may depend on guideline adherence and quality of endoscopy^2,3,4.

Aims & Methods

The aim is to assess whether dedicated (expert) ES (DS) is more effective than conventional (non-dedicated) ES (NS) by means of Key Performance Indicators (KPI), Dysplasia Detection Rate (DDR), use of advanced imaging and complication rate.
This multicentre (5 UK hospitals) retrospective study includes real-world ES data from 1303 procedures conducted within the last 8 years. The endoscopy and histology reports and clinical notes of consecutive procedures were accessed. The data were collected in spreadsheets and then analysed with SPSS-23. Two services were reported demographically and compared with appropriate statistical tests and logistic regression to test factors associated with DDR.

Results

Data from 680 DS and 623 NS procedures were included, comprising 906 (69.5%) males and 397 (30.5%) females (M:F=2.3:1.0). The age ranged from 14-90 yrs with a mean of 63.7 (SD±12.5) yrs. The maximum length of the BO was 18 cm with a mean of 4.1 cm (SD±3.0). There were significant differences in all the KPIs (Prague classification, Barrett’s island description, hiatus hernia delineation, visible lesion documentation, Paris classification, Seattle protocol adherence and inspection time) favoring the DS (P<0.001). Other comparisons: narrow band imaging (NBI, P<0.001), acetic acid chromoendoscopy (AAC, P<0.001), sedation (P=0.02) and acquisition of target biopsies (, P<0.001) were also significantly higher in DS while the complication rate was significantly lower (P=0.05). Importantly, the DDR was significantly higher in DS (58/680 (8.5%)) than in NS (16/623 (2.6%)) with a P<0.001. Regression analysis showed: increasing age, male sex, lesion description and Paris classification documentation were associated with higher DDR (Table 1), while other indicators showed no significant association.

Table 1. Factors associated with dysplasia detection

	Odds ratio	95% CI	P
Age	1.03	1.01 – 1.05	0.002
Sex	1.86	1.16 – 2.98	0.009
Visible lesion documentation	2.23	1.03 – 4.81	0.041
Paris classification	2.19	1.00 – 4.77	0.049

Conclusion

Surveillance for BO through a dedicated service with high quality endoscopy can produce a higher diagnostic yield with improved DDR and a lower complication rate. Given these benefits, large-scale prospective studies are warranted to assess the true impact on mortality, morbidity, cost benefit and patient-reported outcomes, ensuring that surveillance service provides a meaningful clinical benefit, particularly with risk stratification concerning the factors associated with disease progression.

References

Fitzgerald et al. (2013). BSG guidelines on Barrett’s oesophagus. Gut, 63(1), 7–42. doi:10.1136/gutjnl-2013-305372.
Britton et al. (2019). Improving accuracy in Barrett’s surveillance. Frontline Gastroenterol, 10(2), 128–134. doi:10.1136/flgastro-2018-101019.
Ratcliffe et al. (2023). Surveillance service improves dysplasia detection. Frontline Gastroenterol, 15(1), 21–27. doi:10.1136/flgastro-2023-102425.
Ratcliffe et al. (2023). Dedicated Barrett’s surveillance vs. standard care. iGIE, 3(1), 58–65. doi:10.1016/j.igie.2023.11.003.

Conference

UEG Week Berlin 2025

Topics

Oesophagus

Submission format

Abstract

Session

OESOPHAGEAL, GASTRIC AND DUODENAL (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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The journey to become a proactive and involved nurse in the endoscopy room

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