Surveillance for Barrett's oesophagus in the UK

Background: Endoscopic screening for Barrett's oesophagus is being offered without evidence of efficacy Barrett's oesophagus is not an ideal candidate for a screening programme, as the natural history is unclear, uncertaintie s surround the indication for intervention and the treatment is associated with high morbidity and mortality rates. Methods: To determine the practices that clinicians employ in the managemen t of Barrett's oesophagus in the UK, postal questionnaires were sent in May 1997 to 297 randomly selected members of the British Society of Gastroente rology asking for details of their current practice. Results: Of 152 respondents, 106 (70 per cent) performed surveillance for B arrett's oesophagus; 46 (30 per cent) did not carry out screening. There wa s no difference in the practices carried out by physicians or surgeons, tea ching or acute general hospital clinicians, or those with an upper gastroin testinal interest. There was a wide disparity in screening interval: just o ver half (52 per cent) screen at yearly intervals. Only nine (8 per cent) t ook four quadrant biopsies per 2 cm of Barrett's oesophagus. Nearly half (4 9 per cent) manage mild dysplasia by increasing the frequency of endoscopy; only seven (7 per cent) prescribed patients a proton pump inhibiting agent . Faced with severe dysplasia, 33 (31 per cent) offered surgery immediately ; 22 (21 per cent) simply followed the patient by endoscopy. Those not choo sing to perform screening most frequently cited lack of evidence of efficac y as the reason behind their decision. Conclusion: There is wide variation in surveillance practices for Barrett's oesophagus. Some methods are ineffectual. The recommendations made by the Barrett's Oesophagus Working Party in 1991 are not followed, possibly becau se they are not practical. New workable guidelines based on available evide nce and a consensus of expert opinion should be established; this was sugge sted by 38 per cent of respondents who performed screening.