Barrett's oesophagus

Requires Surveillance:

If patient has <1cm of Barrett’s oesophagus then no biopsies and no follow up required.

For those with histologically proven Barrett’s oesophagus ≥1cm length, follow up interval depends on presence of dysplasia and length of Barrett’s segment*

* Follow-up by oesophageal cell collection device ( “Cytosponge”), with endoscopy for selected cases.

Who to refer, who not to refer, how to refer

Who to refer:

Patients with known Barrett’s oesophagus >1cm

Who not to refer:

Do not routinely offer OGD to those with GORD to diagnose Barrett’s especially if age <55

How to refer:

Refer for upper GI endoscopy rather than GI clinic referral. Endoscopy referrals will be triaged so please include all relevant information.

Borders General Hospital -> Endoscopy -> Endoscopy B

Primary care management

Barrett’s Oesophagus Treatment

Offer long term maintenance full dose PPI (e.g. omeprazole 20mg daily)
Remain on full dose PPI (high dose may be necessary to control symptoms)

High dose PPI (e.g. omeprazole 40mg daily)

Switch to another PPI at full or high dose if initial PPI fails to control symptoms

Follow up of Barrett’s oesophagus

If patient has < 1cm of Barrett’s oesophagus, then no biopsies and no follow up required
After diagnosis follow up interval depends on:

presence of dysplasia and length of Barrett’s segment

If dysplasia is absent at index OGD, the patient will be considered for Cytosponge, repeated in 1 year
If dysplasia is absent at 1year, subsequent follow up interval depends on length of Barrett’s segment.

Barrett’s >3cm

OGD or Cytosponge every 3 years**

All others

OGD or Cytosponge every 5 years**

**Follow-up currently by Cytosponge with endoscopy for selected cases

Further Information

The presence of low- or high-grade dysplasia will usually lead to MDT referral and/or endoscopic therapy: this will be sorted in secondary care once histology results available.

If there is doubt about presence of dysplasia OGD is repeated after 6 months (usually with increased PPI dose).