Dedicated Endoscopy for Barrett's Oesophagus With Higher Dysplasia Yield May Reduce Seattle Protocol Biopsies: Results From UK Multicentre Study

BACKGROUND: Dedicated service for Barrett's oesophagus (BO) surveillance may be more effective than conventional service, according to some single centre studies. OBJECTIVE: To determine whether the surveillance of BO through a dedicated service can improve key performance indicators (KPIs), and dysplasia detection rate (DDR) compared with conventional service in a multi centre study. METHODS: A retrospective cohort study was conducted across 6 NHS-hospitals, capturing BO surveillance data over 8 years. Factors associated with DDR were assessed by logistic regression. RESULTS: There were 1037 dedicated and 976 conventional surveillance procedures (N = 2013), male: female ratio = 2.2:1; mean age = 64.4 (SD ± 12.2) years; mean maximum length of BO = 4.1 cm (range: 0-18 cm). All the KPIs and DDR were significantly higher in the dedicated service (DDR = 6.9%) than in the conventional service (DDR = 2.8%), p < 0.001. The use of narrow band imaging (NBI) and acetic acid chromoendoscopy (AAC) and sedation were high, and the complication rate was significantly lower in the dedicated service. The lesion recognition was significantly associated with DDR (OR = 6.9). Surprisingly, Seattle biopsy protocol adherence showed no correlation with DDR (OR = 0.47). CONCLUSION: The dedicated service provides higher quality endoscopy, and a higher yield of early neoplasia. It uses more sedation, advanced imaging, and detects more lesions than conventional services. Thus, the dedicated surveillance could potentially replace time and cost consuming Seattle biopsies with targeted biopsies of visible lesions. In future, this may become easier with the use of artificial intelligence for lesion detection (CADe).