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Safer Care Victoria’s Best Care resources support patients and healthcare providers to have conversations and make decisions together about the most appropriate pathways for care.

This resource, developed for clinicians, details a specific elective surgery procedure that should now only be done for specific indications. Evidence-based recommendations that detail ‘best care’ pathways should be discussed with your patient to determine the most appropriate pathway of care.

Advice

A surveillance gastroscopy is indicated no more than every three years for a person with Barrett’s oesophagus where no dysplasia has been found on previous four quadrant biopsies. The interval is dependent on the length of Barretts previously seen on endoscopy; i.e. three yearly intervals for short segment (<3cm) or every two to three years for long segments (≥3cm).

When is the procedure indicated?

If red flag symptoms suggesting upper gastrointestinal pathology develop, a surveillance gastroscopy should be done before the three-year indicator for a person with Barrett’s oesophagus where no dysplasia is found on previous four quadrant biopsies.

Best care recommendations

The risk of developing cancer in a patient with Barrett’s oesophagus without dysplasia is low.  

Recommended treatment of these patients is with a prescribed proton pump inhibitor (once daily), even if the patient is asymptomatic.  The patient must be clinically reviewed once a year or sooner if red flag features develop (dysphagia, anaemia, bleeding, unintentional weight loss, change in reflux symptoms).   

The potential risks and benefits of three yearly surveillance gastroscopy should be discussed with the patient.

Lifestyle modifications that can reduce the patient’s risk of developing dysplasia, such as weight management and quitting smoking, should also be discussed.

Evidence

Department of Health and Human Services. Specialist clinics resources: The Victorian Endoscopy Categorisation Decision Support Tool [Internet]. Melbourne (VIC): Department of Health and Human Services; 2017 [cited 2020 Nov 20].

Kendall B. Cancer Council Australia Barrett's Oesophagus Guidelines Working Party. How frequently should patients with BO undergo endoscopy? [Internet]. Sydney (NSW): Cancer Council Australia; 2015 [cited 2020 Oct 12]. In: Cancer Council Australia Barrett's Oesophagus Guidelines Working Party. Clinical practice guidelines for the diagnosis and management of Barrett’s oesophagus and early oesophageal adenocarcinoma. Sydney (NSW): Cancer Council Australia.

NPS MedicineWise. Choosing Wisely Australia recommendations [Internet]. Sydney (NSW): NPS MedicineWise; 2016 [cited 2020 Jun 25].

Shaheen NJ, Falk GW, Iyer PG, Gerson LB. ACG clinical guideline: diagnosis and management of Barrett’s esophagus. American Journal of Gastroenterology. 2016 Jan 1;111(1):30-50.

Page last updated: 09 Feb 2021

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