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:

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

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).

Editorial Information

Author(s): Jonathan Fletcher, Angus Wallace.

Author email(s): bor.gastroenterology@borders.scot.nhs.uk, .