Oesophagopharyngeal

Question 1

Who should be screened for Barrett’s oesophagus?

Answer 1

1. Family history of Barrett’s oesophagus
2. Or Family history of oesophageal Adenocarcinoma
3. Chronic GORD (>5 years duration) + 3 risk factors
4. Severe GORD (symptoms twice weekly or interfering with daily activity) + 3 risk factors

Risk factors:
>50
White race
Obese
Smoker
Male

Question 2

How is Barrett’s oesophagus screening/diagnosis carried out?

Answer 2

Endoscopy to visualise salmon coloured columnar epithelium clearly extending above the gastrooesophageal junction - provisional diagnosis.

Upon visualising it, biopsy of four quadrants and any lesions is carried out, and subsequent histopathological examination - confirmation of diagnosis.

Question 3

A patient presents with dysphagia, what investigations should be carried out?

Answer 3

1. Oesophagastroduodenoscooy with biopsy of any metaplasia or lesions (OGD/gastroscopy - upper GI endoscopy)
2. U+E’s - for kidney function in case of contrast CT for looking for metastases (dysphagia is a red flag)
3. FBC - check for anemia
4. LFTs -check for metastases
5. Histopathology of any biopsies and discussion at MDT meeting

Question 4

What are the criteria for referral to the urgent suspected oesophageal cancer pathway?

Answer 4

1. Anyone with dysphagia
2. Or >55 with weight loss and any of the following:
   - upper abdominal pain
   - reflux
   - dyspepsia

Important to give the patient an early warning shot: mention cancer

Question 5

What are the criteria for non-urgent referral for OGD to assess suspected oesophageal cancer?

Answer 5

Non-urgent referal is for:
1.haematemesis

2. treatment‑resistant dyspepsia
3. upper abdominal pain with low haemoglobin levels
4. raised platelet count with; Nausea or vomiting or weight loss or dyspepsia or upper abdominal pain
5. nausea and vomiting with; weight loss or dyspepsia reflux or upper abdominal pain

Question 6

What are the important investigations and tests for people suspected of having oesophageal cancer?

Answer 6

OGD
Bloods
ECG
PEFR
CXR
Oesophageal USS (staging of cancer
CT-thorax/abdomen/pelvis (metastases)
PET (metastases)
CPx testing (fitness for surgery)

Question 7

Since oesophageal cancer lesions are quite friable, what might we see on endoscopic investigation?

Answer 7

Bleeding in the oesophagus, since the tumours are fragile and easily damaged.