Introduction The importance of early recognition of dysplasia within a segment of Barrett’s oesophagus (BO) is well recognised, due to the risk of progression to oesophageal cancer. National guidelines on endoscopic surveillance are published in Gut 2014.

Method A retrospective audit of endoscopies for all patients with BO between January and November 2018 was conducted.

Data collected included the number of endoscopists involved, patient characteristics, and adherence to the Prague and Seattle biopsy protocol. The histology data was extracted from the pathology reporting system and follow up was checked using endoscopy reports and clinic letters.

Results 136 cases of BO were identified by 17 different endoscopists. 47% had known a diagnosis of BO, and the remaining patients had a new diagnosis. 88% cases were reported using Prague Classification. The Seattle biopsy protocol was adhered to in 82 66% cases.

Only 2/8 cases of dysplasia were confirmed by a second independent pathologist. The BSG guidance states that all cases must be reviewed by a second pathologist.

The plan for follow up varied: 47% outpatient clinic, 25% virtual clinic, 5% GP, 4% MDT and 19% unclear.

Conclusions This audit highlighted the need for a structured surveillance program for detection and management of dysplasia in patients with BO.

Key issues highlighted were large number of endoscopists involved and lack of a standard approach to tissue sampling, reporting and follow up. Booking of surveillance was variable and inadequate. Patients were also unnecessarily being booked into clinics- suggesting that resources were not being used the most effectively.

Results were presented at a local department meeting and the following changes agreed;

1. Introduction of regular BO surveillance lists by a dedicated endoscopist to standardise reporting, improve on dysplasia detection.

2. Follow up with initial clinic appointment to discuss diagnosis and surveillance, thereafter via virtual clinic.