Surveillance of Barrett's oesophagus: physicians' practices and review of current guidelines

Background Endoscopic biopsy surveillance of Barrett's oesophagus is genera lly recommended, However, optimal patient selection and frequency of follow -up are subject to ongoing discussion. Objective To investigate current surveillance practices for Barrett's oesop hagus in the Netherlands and to explore their concordance with the guidelin es for Barrett's oesophagus surveillance as recommended by the Internationa l Society for Diseases of the Esophagus (ISDE). Methods An anonymous questionnaire was mailed to 269 specialist physicians working in the field of gastroenterology. Results The response rate was 88% (238/269), Most of the respondents (84%) performed regular endoscopic follow-up of Barrett's oesophagus, In 52%, end oscopic biopsy sampling corresponded to the ISDE guidelines (four-quadrant biopsies at 2 cm intervals). Agreement was 60% regarding the interval of su rveillance for no dysplasia (every 2 years), 52% regarding the interval for low-grade dysplasia (every year) and 54% for management of high-grade dysp lasia (oesophagectomy if diagnosis confirmed by a second pathologist or re- biopsy in the short term). When combining these three items, consistency wi th the ISDE guidelines decreased to 25%, Criteria to select patients for su rveillance included age, presence of symptoms, length of Barrett's oesophag us and type of Barrett epithelium. Conclusions The survey indicates widespread practice of cancer surveillance for patients with Barrett's oesophagus in the Netherlands. However, there is limited uniformity in the frequency and intensity of endoscopic histolog ical follow-up. This variability in clinical practice may result from confl icting data and recommendations in the literature. Updated consensus is nee ded in this area. (C) 2000 Lippincott Williams & Wilkins.