HOME
Return to Table of Contents
SURVEILLANCE FOR BARRETT’S ESOPHAGUS IN BRITISH COLUMBIA: A RETROSPECTIVE ANALYSIS
A Chang1,2, P Kazemi1,3, W Chung1,3, L Soswa1,3, A Hassanali1,3, I Bregman1,3, SE Krausz1,4, J Lee1,2, W Haniak5, N Chatur6, R Enns1
1St Paul’s Hospital, University of British Columbia, Division of Gastroenterology; 2University of British Columbia, Department of Internal Medicine; 3University of British Columbia, Department of Medicine; 4Lion’s Gate Hospital, Vancouver BC, 5University of Western Ontario, Department of Medicine, London, ON, 6Vancouver General Hospital, University of British Columbia, Division of Gastroenterology, Vancouver, BC
Purpose: In 2002, the American College of Gastroenterology (ACG) published updated guidelines for surveillance of Barrett’s Esophagus (BE). The purpose of this study was to examine endoscopic surveillance of BE patients of a sample population in BC to assess guideline adherence.
METHODS: A retrospective chart review study was conducted at three major hospitals in Vancouver, Canada screening for esophogastroduodenoscopies (EGD) with confirmed BE based on pathological reports. Data collected included age, gender, endoscopist, diagnosis (including presence of low or high grade dysplasia and esophageal adenocarcinoma), biopsy protocols and follow-up endoscopy dates.
RESULTS: From 01/03-06/07, 363 EGD with BE were reviewed (196 males) with a mean age of 62.0 yrs (range 30-86). Of these, 12 patients had low-grade dysplasia (LGD), 3 had high-grade dysplasia (HGD) and 7 had esophageal adenocarcinoma (of the latter group, only one patient progressed to cancer from HGD). 19 endoscopists were surveyed, ranging from less than 5 to >20 years of practice. Of the 363 endoscopies, only 88 (24.2%) had four quadrant biopsies performed q2cm as stated on endoscopy report; furthermore, 21 of these 88 had pathology reports that did not agree with the stated number of biopsies. 71 (19.6%) EGD had reports which either did not specify the Barrett’s length, or the number of samples taken from biopsy. Of the 12 LGD patients, only 4 had four quadrant biopsies q2cm. The 3 HGD patients had proper number of biopsies and follow-up.
CONCLUSIONS: Endoscopic surveillance techniques for BE in this retrospective preliminary study appear variable, without close adherence to ACG 2002 guidelines. Further data to substantiate this will be collected and reasons for this explored.