My Experience of Clinical Practice for Barrett’s Oesophagus and Oesophageal Adenocarcinoma in the UK

Background: The incidence of Barrett’s oesophagus (BO) and oesophageal adenocarcinoma (OAC) in Japan is lower than in Western Countries. However, increased popularity of a western diet and increasing prevalence of obesity in Japan may result in higher incidence of BO and OAC in the future. Thus, the author visited the UK, which has the similar diagnostic criteria for BO compared to Japan, to experience real clinical practice for BO/OAC. Aim: To report on clinical practice for the management of BO and OAC in a geographical area with high incidence of BO/OAC. Method: The author visited the co-authors in the UK, who have coordinated the 2013 British Society of Gastroenterology guidelines for the management of BO 2013. Result: In the UK, reporting of BO cases adheres to a minimum dataset including Prague classification for BO length, number of biopsies according to the Seattle protocol and standardized histopathological diagnosis. These cases are managed by a Multi-Disciplinaty Team (MDT) including physicians from different specialties which meets on a weekly basis to discuss cases from the regional population of 1.2 million across 4 hospitals. The MDT improves sharing of patients’ information as well as knowledge of BO/OAC practice and standardization of care. Chemotherapy is given locally but surgery is centralized to Cambridge. Patients with high grade dysplasia and early cancer are entered into a national database. Conclusion: Japan has lessclinical experience of BO and associated adenocarcinoma compared to western countries. Introduction of national databases and MDTs will improve in Japan management of this condition.