Barrett’s Oesophagus and Barrett’s Mucosa
Endoscopy Procedure in Barrett’s Oesophagus
Doctors need to know whether a person with Barrett’s oesophagus is at risk of developing cancer. The best way to do this currently is endoscopy – to look inside with a flexible tube which has a video camera built in.
During the endoscopy test, the doctor can take small samples from the lining of the oesophagus. These are called biopsies. The biopsies are sent to the pathologist who will examine them and determine whether dysplasia is developing. Dysplasia is the most powerful sign that an individual is moving along the pathway to developing cancer.
Should People with Barrett’s have Regular Endoscopic Surveillance?
All the major international specialist groups including the British Society of Gastroenterology recommend regular endoscopy for people with Barrett’s oesophagus. The reason is simple. It allows doctors to spot early changes in cells as they move to being cancerous.
Remember – the vast majority of people with Barrett’s oesophagus never actually get cancer. But if they do, early detections means the cancer can still be treated. There is plenty of evidence that people who have regular endoscopies have a higher chance of cure even if they develop cancer.
It is also now possible to treat people before cancer develops. This is only appropriate in some people. It is possible to assess who would benefit from this type of treatment by analysing the biopsy samples taken at endoscopy .
There is some uncertainty, however. Since most people with Barrett’s oesophagus never get cancer, it is not absolutely clear that everyone should have surveillance.
How Often to Survey?
The British Society of Gastroenterology issued new guidance in 2013.
The new guidelines divide sufferers into those with:
- ‘short segment’ Barrett’s (SSBE), where it is less than 3cm long and
- ‘long segment’ Barrett’s (LSBE) which is more than 3 cm long.
For patients with short segment Barrett’s, they sub-divide into:
- people with intestinal metaplasia
- people without intestinal metaplasia
(They do not divide people with long segment because intestinal metaplasia is present in almost everyone with long segment Barrett’s)
Recommended Surveillance Intervals
Short Segment Barrett’s Oesophagus, no intestinal metaplasia
- Repeat the endoscopy to confirm the diagnosis
- Discharge from follow up as the cancer risk is so small that the risks of doing repeated endoscopy outweighs the risk of getting cancer
Short Segment Barrett’s Oesophagus, with intestinal metaplasia
- Regular surveillance endoscopy every 3 to 5 years
Long Segment Barrett’s oesophagus
- Regular surveillance endoscopy every 2 to 3 years
Who should do the endoscopy procedures?
This should be easy to answer? All gastroenterologists are trained to do endoscopy to a high standard. So are nurse endoscopists. So, surely anyone can do this well?
Well, actually, our experience is that this is simply not true. Endoscopic surveillance of Barrett’s oesophagus is a specialist procedure. Many general endoscopists do not do it particularly well.
Common mistakes doctors can make at endoscopy include:
- Not identifying the Barrett’s oesophagus correctly
- Not taking the right number of biopsies
- Not working with specialist pathologists
How should it be done?
High quality surveillance requires all of the following:
Familiarity with Barrett’s
- Someone who sees lots of cases is more likely to detect subtle abnormalities
- The latest endoscopy equipment – pre-cancerous changes are subtle. The better the technology used, the more likely tiny abnormalities will be detected. Tiny abnormalities today can become rather large abnormalities in a few months time
Rigorous biopsy protocols
- Most endoscopists do not take many biopsy samples.
- There is excellent evidence that the more biopsies the doctor takes, the more likely they are to find early abnormalities such as dysplasia
- If you are not sure, ask your doctor whether they take quadrantic biopsies (one biopsy in each quarter of the clock face) every 1 or 2 cm throughout the entire length of the Barrett’s
- Another way of asking this is “How long is my Barrett’s?”
Multiply the answer in your head by 2. So if the Barrett’s is 5cm long, the answer is 10
Then ask how many biopsy samples the doctor expects to take? If it is less than 10, the doctor is not following the best guidance.
Advanced Endoscopic Techniques
There are a number of enhancements to a standard endoscopy procedure that can help the doctor identify pre-cancerous abnormalities.
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We recommend that endoscopy procedures should be undertaken by experts. We offer this service. Make an appointment with one of our specialists who will be able to advise you. Please tell our office staff that you want to see an expert in Barrett’s oesophagus. We will ensure you see the right person.