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

Background—Barrett's metaplasia is a premalignantcondition for which screening is recommended.
Aims/methods—Annual screening endoscopies havebeen performed on all subjects suitable for surgery for many years. Toexamine 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 overthis period, Barrett's metaplasia was present in 1.4%. There was anapproximate equal sex distribution with the majority of cases beingidentified in patients over 50 years old. Thirty five per cent of thesepatients were suitable to enter a yearly screening programme. Duringscreening, the length of oesophagus involved did not vary over time. Asa result of 379 endoscopies performed for screening purposes, only onepatient was identified as developing carcinoma solely as a result ofthe screening programme. Two further patients had carcinoma identifiedas a result of progressive dysphagia requiring additional endoscopies.All three patients who developed carcinoma while in the screeningprogramme had "long segment" (>8 cm) regions of Barrett'smetaplasia with a stricture present at the initial endoscopy.
Conclusions—The poor yield from this screeningprogramme suggests that the policy should be reconsidered. Resourcesmay be better spent on focusing on patients who present with ulceration or stricture in addition to Barrett's metaplasia.

Keywords:malignancy; endoscopy; oesophageal carcinoma