Dedicated services for Barrett’s esophagus—a survey and service assessment of provision in United Kingdom hospitals

Abstract

Background: Specialist services in medicine are increasingly recognised as gold standard care, in gastroenterology, studies of Barrett’s esophagus (BE) suggest dedicated services show better adherence to surveillance protocols and concomitant dysplasia detection. The aim of this study was to gain insight into the BE practice in UK hospitals. Methods: Adult endoscopy units in the UK were contacted via phone or email and asked to complete a 9-question survey about their BE service. Results: Two hundred and sixty-five units (~95%) were contacted with a response rate of 61.9% (164/265), 56.3% (85/151) reported a dedicated BE service. Having a dedicated BE service was associated with the use of high-resolution white light (92.9% vs . 71.2%, P=0.001) and acetic acid (83.5% vs . 48.5%, P<0.001) and the availability of advanced endoscopic therapies such as radiofrequency ablation (43.5% vs . 19.7%, P=0.004). Trusts which reported a dedicated BE endoscopy service were more likely to have a dedicated BE clinic (52.9% vs . 16.7%, P<0.001) and a named BE lead (85.9% vs . 31.8%, P<0.001). Conclusions: Dedicated services for BE are available in the UK and associated with quality indicators, work is needed to determine the efficacy and efficiency of this model of service. carries a with a been one of the of need by Cancer Research UK and they estimate 59% of esophageal cancers are preventable (4). In order to detect dysplasia and early cancers, international and national guidelines advise regular surveillance endoscopy procedures performed every 2–5 years, during which visible abnormalities are targeted for biopsy and quadrantic biopsies every 1–2 cm (Seattle protocol biopsies) are performed to try to detect early changes (5-7). Retrospective studies have shown there are outcomes for patients on surveillance (8) and adherence to Seattle protocol leads greater for the detection of dysplasia (9).