An Audit of the Biopsy Protocol for Barretts Eosophagus – Need to Improve Compliance to Guidelines?

Introduction: Guidelines exist regarding the number and interval of endoscopic biopsies for surveillance of Barrett's esophagus. However, the data on compliance is widely variable. We aimed to audit the Barrett's biopsy protocol practice at our institution.

Methods: Endoscopy and histology records of patients with Barrett's esophagus diagnosed from August 2000 to June 2003 were reviewed for appropriateness of site, number and interval of biopsies. Based on the results of this retrospective data, the ACG guidelines were disseminated and a prospective audit of the practice was initiated. The results of the first 3 months of the prospective audit are presented.

Results: In the retrospective audit of 441 patients with Barrett's esophagus, adherence to guidelines on biopsy protocol was observed in only 10 episodes (2.49%). There was no difference in compliance among medical and surgical endoscopists or between trainees and consultants. Fourteen patients had dysplasia (6 high grade, 6 indefinite) and 2 adenocarcinomas were identified. In the prospective phase, 52 patients with Barrett's had endoscopic biopsies. Biopsy protocol according to guidelines was followed in 28 (53.84%) patients. There was significant difference between medical and surgical endoscopists. High-grade dysplasia was noted in one patient.

Conclusion: This single center audit confirms non-compliance to practice guidelines for biopsy of Barrett's esophagus. The impact of adherence to guidelines on detection of significant pathology is unclear.