Ten years' experience of screening patients with Barrett's oesophagus in a university teaching hospital

Abstract

Background: Barrett's metaplasia is a premalignant condition for which screening is recommended.

Aims/methods: Annual screening endoscopies have been performed on all subjects suitable for surgery for many years. To examine the benefits to patients of continuing this policy 10 years' experience of screening for Barrett's oesophagus was reviewed.

Results: Of the 29,374 endoscopies performed over this period, Barrett's metaplasia was present in 1.4%. There was an approximate equal sex distribution with the majority of cases being identified in patients over 50 years old. Thirty five per cent of these patients were suitable to enter a yearly screening programme. During screening, the length of oesophagus involved did not vary over time. As a result of 379 endoscopies performed for screening purposes, only one patient was identified as developing carcinoma solely as a result of the screening programme. Two further patients had carcinoma identified as a result of progressive dysphagia requiring additional endoscopies. All three patients who developed carcinoma while in the screening programme had "long segment" (> 8 cm) regions of Barrett's metaplasia with a stricture present at the initial endoscopy.

Conclusions: The poor yield from this screening programme suggests that the policy should be reconsidered. Resources may be better spent on focusing on patients who present with ulceration or stricture in addition to Barrett's metaplasia.

Figure 1

: Number of new patients identified in our endoscopy unit as having Barrett's metaplasia present over the period 1984-1994. Black columns represent male patients and white columns female patients.

Figure 2

: Age of patients at time of initial diagnosis of Barrett's metaplasia. Black columns represent male patients and white columns female patients.

Figure 3

: Symptoms or clinical indication for the initial endoscopy which led to the recognition of the presence Barrett's metaplasia. Black columns represent male patients and white columns female patients. GORD, symptoms suggestive of gastro-oesophageal reflux. Review, repeat endoscopy to confirm healing of benign gastric ulceration where Barrett's metaplasia was not commented on at the initial endoscopy.

Figure 4

: Pie chart showing the percentage of potentially suitable patients who entered the screening programme and the main reason for exclusion in the rest.