S3142 Adherence to Seattle Biopsy Protocol in Patients With Long Segment Barrett’s Esophagus at Cairns Hospital, Australia

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INTRODUCTION: The Seattle protocol recommends extensive systematic biopsy sampling as a form of surveillance for patient with Barrett’s esophagus (BE) to detect dysplasia and early stage adenocarcinoma. Seattle protocol recommends 4-quadrant biopsies at 2-cm intervals in patients without dysplasia and 1-cm intervals in patients with prior dysplasia. The rate of adherence to the biopsy sampling guidelines has not previously been studied in Australia. The aim of this study was to interpret data from the biopsy sampling practice in long segment Barrett’s esophagus (LSBE), assess histopathological findings, rate of adherence to Seattle protocol and disparities within the department. METHODS: This retrospective study was performed with the help of “ProVationMD”, an endoscopy reporting system and the electronic medical record system of the hospital, which were used to collect demographic data, medical evaluation, histopathological report, number of biopsies and length of LSBE according to Prague Classification. In a period of 5-years (Jan 2015–Dec 2019), 11152 Esophagogastroduodenoscopies (EGDs) were performed at Cairns Hospital including 264 cases of LSBE that underwent surveillance biopsies, completed by 25 doctors including 18 gastroenterologists (229 cases), 3 surgeons (7 cases), 3 internists/registrars (16 cases) and 1 general practitioner (12 cases). RESULTS: The incidence rate of LSBE was 2.36%. The majority were males (79%) and had a mean age of 62 (SD ± 12.5) years. 72 endoscopic procedures (27%) were fully adherent to Seattle Protocol. Gastroenterologists followed the protocol in 61 procedures (26%), internists/registrars in 6 (37%), general practitioner in 4 (33%) and surgeons in 1 (14%) (Figure 1). Average rate of adherence to the Seattle Protocol per procedure by different clinician groups is shown in Figure 2. In total, 2926 biopsies should have been collected from 264 procedures according to Seattle Protocol but only 1736 (59.3%) were takenFigure 1.: EGD Procedures with Full Seattle Protocol Adherence at Cairns Hospital.Figure 2.: Adherence to Seattle Protocol per Procedure within Departments at Cairns Base Hospital.Figure 3.: Biopsy Reports of 264 Long Segment Barrett’s Esophagus Patients at Cairns Hospital.. The biopsy reports showed no dysplasia in 86.7%, indefinite dysplasia in 6.4%, low-grade dysplasia in 6.4%, high-grade dysplasia in 1.89% and adenocarcinoma in 0.75% (Figure 3). CONCLUSION: Seattle Protocol was fully followed in only 27% of procedures. Rate of adherence to the protocol per procedure was highest among gastroenterologist followed by general practitioners, internists/registrars and surgeons. Only 59.3% of the expected number of biopsies were taken. Our study shows a low adherence to the Seattle Protocol.

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