{
  "abstract": "Introduction Barrett’s oesophagus predisposes to oesophageal adenocarcinoma. High-quality surveillance endoscopy is required to reduce post-endoscopy upper GI cancer and associated harm from delayed/missed diagnoses. The UK National Endoscopy Database (NED) provides a platform for large-scale evaluation of endoscopic performance. As part of a broader assessment of UGI endoscopy quality, we evaluated Barrett’s surveillance practice across the UK and examined sources of potential variation.Methods All UGI endoscopies submitted to the latest iteration of NED (NEDi2) for the year 2024 were analysed. Barrett’s surveillance procedures were identified using recorded indication fields. Key performance indicators (KPIs) assessed included sedation use, procedure duration, compliance with the recommended Barrett’s inspection time (≥1 minute per centimetre of Barrett’s segment), and compliance with the Seattle biopsy protocol (four biopsies per 2 cm). Focal lesion detection was captured using NED diagnostic fields. Mixed-effects multivariable regression models were used to evaluate the association between annual procedure volume (all UGI endoscopies), and Barrett’s surveillance frequency (≥25 procedures per year vs. <25) and KPI performance, adjusting for endoscopist profession, Barrett’s length, patient age and sex, with endoscopist as a random effect (to account for clustering).Results A total of 26,898 Barrett’s surveillance endoscopies (performed by 2,828 endoscopists) were performed. Sedation was used in 45.5% (95% CI 44.9-46.1). Among sedated patients, 55.2% (95% CI 55.4-56.0) received combined opioid + midazolam, and 13.4% (95% CI 12.8-14.0) received above the recommended dose for age. The focal lesion detection rate was 3.7% (95% CI 3.5-4.0). 68.7% (95% CI 67.8-69.6) of procedures were compliant with the Seattle biopsy protocol, and 74.7% (95% CI 73.9-75.6) met the Barrett’s inspection-time target. 14.8% of endoscopists undertook ≥25 surveillance procedures per year.In adjusted analyses, sedated procedures showed significantly greater odds of focal lesion detection (OR 1.66, 95% CI 1.36-2.01, p<0.001). Endoscopists performing ≥25 surveillance procedures per year showed significantly higher focal lesion detection (OR 1.36, 95% CI 1.11-1.68, p=0.003). Those performing ≥25 surveillance procedures per year had longer total procedure durations (+0.79 minutes, 95% CI +0.27 - +1.31, p=0.003), but were not associated with increased Barrett’s inspection time recommendation compliance (OR 1.48, 95% CI 0.92-2.38, p=0.11).Conclusions Substantial variation exists in the quality of Barrett’s surveillance. Endoscopists performing regular surveillance appear to achieve better lesion detection. Variation in sedation practice, particularly under-use of combined sedation, represents a potentially modifiable factor. NED data relies on endoscopists completing thorough and accurate reports, but may provide a scalable mechanism for national quality assurance.",
  "authors": [
    {
      "affiliations": [
        "Joint Advisory Group on GI Endoscopy, Exeter, United Kingdom",
        "Torbay and South Devon NHS Foundation Trust, United Kingdom"
      ],
      "name": "Keith Pohl"
    },
    {
      "affiliations": [
        "Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom"
      ],
      "name": "Amar Srinivasa"
    },
    {
      "affiliations": [
        "Joint Advisory Group on GI Endoscopy, Exeter, United Kingdom"
      ],
      "name": "Aaron Bhakta"
    },
    {
      "affiliations": [
        "Torbay and South Devon NHS Foundation Trust, United Kingdom"
      ],
      "name": "Mark Feeney"
    },
    {
      "affiliations": [
        "Joint Advisory Group on GI Endoscopy, Exeter, United Kingdom"
      ],
      "name": "David Beaton"
    },
    {
      "affiliations": [
        "Joint Advisory Group on GI Endoscopy, Exeter, United Kingdom"
      ],
      "name": "Nicholas Burr"
    },
    {
      "affiliations": [
        "Joint Advisory Group on GI Endoscopy, Exeter, United Kingdom"
      ],
      "name": "Tom Lee"
    },
    {
      "affiliations": [
        "Joint Advisory Group on GI Endoscopy, Exeter, United Kingdom"
      ],
      "name": "Matt Rutter"
    },
    {
      "affiliations": [
        "Joint Advisory Group on GI Endoscopy, Exeter, United Kingdom",
        "Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom"
      ],
      "name": "Nigel Trudgill"
    }
  ],
  "title": "P9 Evaluating the quality of Barrett’s oesophagus surveillance in the UK: findings from the national endoscopy database (NED)",
  "uid": "0a3e9d6b-902a-5dda-963c-24381d1f3f19"
}