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

Endoscopic biopsy surveillance of Barrett's oesophagus is generally recommended. However, optimal patient selection and frequency of follow-up are subject to ongoing discussion.

To investigate current surveillance practices for Barrett's oesophagus in the Netherlands and to explore their concordance with the guidelines for Barrett's oesophagus surveillance as recommended by the International Society for Diseases of the Esophagus (ISDE).

An anonymous questionnaire was mailed to 269 specialist physicians working in the field of gastroenterology.

The response rate was 88% (238/269). Most of the respondents (84%) performed regular endoscopic follow-up of Barrett's oesophagus. In 52%, endoscopic biopsy sampling corresponded to the ISDE guidelines (four-quadrant biopsies at 2 cm intervals). Agreement was 60% regarding the interval of surveillance for no dysplasia (every 2 years), 52% regarding the interval for low-grade dysplasia (every year) and 54% for management of high-grade dysplasia (oesophagectomy if diagnosis confirmed by a second pathologist or re-biopsy in the short term). When combining these three items, consistency with the ISDE guidelines decreased to 25%. Criteria to select patients for surveillance included age, presence of symptoms, length of Barrett's oesophagus and type of Barrett epithelium.

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 histological follow-up. This variability in clinical practice may result from conflicting data and recommendations in the literature. Updated consensus is needed in this area.