Barrett's oesophagus – patient guide
Practical guide for patients with suspected or known Barrett's oesophagus: what the gastroscopy involves, how to prepare, and how the surveillance pathway is organised in line with the Danish Society of Gastroenterology and Hepatology (DSGH) recommendations.
Patient Guide: Barrett's Oesophagus
This clinical guide is designed for patients with known or suspected Barrett's oesophagus, integrating international standards and the official Danish Society for Gastroenterology and Hepatology (DSGH) guidelines.
For a fuller overview of the condition, see our blog article on Barrett's oesophagus.
What is Barrett's oesophagus?
Barrett's oesophagus is a condition where the normal stratified squamous epithelium lining the lower oesophagus is replaced by simple columnar epithelium with goblet cells (intestinal metaplasia), typically caused by chronic gastroesophageal reflux disease (GERD).
Diagnostic criterion: To establish a formal diagnosis, the endoscopically visible mucosal segment must be ≥ 1 cm above the gastroesophageal junction. Segments under 1 cm are not classified as Barrett's oesophagus due to an extremely low risk of malignant progression.
When should you be referred?
Talk to your GP about a referral for gastroscopy if you have:
- Reflux symptoms for more than 5 years, combined with at least two risk factors: age > 50, male sex, central obesity, current or former smoking, or Barrett's oesophagus / oesophageal cancer in close family.
- Alarm symptoms: difficulty swallowing (dysphagia), pain on swallowing (odynophagia), unexplained weight loss, vomiting blood, or black stools.
The procedure (gastroscopy and biopsies)
The diagnosis is verified by gastroscopy with biopsies:
- The examination is performed with high-definition (HD) endoscopy and virtual chromoendoscopy (NBI).
- The extent is recorded carefully using the Prague classification (C & M criteria).
- Systematic biopsies are taken according to the Seattle protocol (4-quadrant biopsies every 2 cm throughout the segment) plus targeted biopsies from any visible irregularities.
You may choose between oral gastroscopy (through the mouth) or nasal gastroscopy (through the nose, without sedation). Read more in our patient guide to gastroscopy and the article nasal vs. oral gastroscopy.
Preparation
- Fasting: No solid food or dairy from midnight before the procedure. Clear fluids are permitted up to 2 hours before your appointment.
- PPI washout (important): Proton pump inhibitors (PPIs) must be discontinued for 2 weeks prior to the baseline diagnostic endoscopy to allow optimal macroscopic and histological assessment.
- Blood-thinning medication: Contact the clinic in good time for a pause plan (applies to warfarin/Marevan, DOACs, clopidogrel). Low-dose aspirin (Hjertemagnyl) should not be paused.
Surveillance and follow-up intervals
The follow-up plan is determined by segment length and the presence of dysplasia, per DSGH:
| Segment length / histology | Surveillance interval (DSGH guidelines) |
|---|---|
| Short segment < 3 cm (without intestinal metaplasia) | No routine surveillance required |
| Short segment < 3 cm (with confirmed intestinal metaplasia) | Every 5 years |
| Long segment ≥ 3 cm and < 10 cm | Every 3 years |
| Extremely long segment ≥ 10 cm | Direct referral to a tertiary expert centre |
| Indefinite for dysplasia | Optimise PPI therapy and repeat gastroscopy after 6 months |
| Low-grade dysplasia (LGD) | Must be confirmed by a second expert pathologist. Endoscopic eradication or close follow-up (6-12 months) |
| High-grade dysplasia (HGD) / early cancer | Immediate referral to an expert centre for endoscopic resection (EMR/ESD) and radiofrequency ablation (RFA) |
References
- Danish Society of Gastroenterology and Hepatology (DSGH). National clinical guideline on Barrett's oesophagus.
- Fitzgerald RC, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus. Gut. 2014.
- Shaheen NJ, et al. ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus. Am J Gastroenterol. 2016.
Book an appointment
You are welcome to contact the clinic to book an appointment or ask questions. With a referral from your GP, the procedure and follow-up are free of charge.
CONTACT INFORMATION
Hans Edvard Teglers Vej 9, 1st floor. 2920 Charlottenlund
- Tel.: +45 39 64 01 25
- Email: mail@kirurgen.dk
BOOKING AN APPOINTMENT
Our phone lines are open Monday-Thursday from 9 a.m. to 12 p.m.
FOR REFERRING DOCTORS
Provider Number 215430
How to book
Online booking is not available. Call the clinic or ask your GP for a referral.
With a referral from your GP, treatment is free under the Danish public health insurance.
Call the clinic
+45 39 64 01 25
Phone hours
Phone hours: Mon–Thu 09:00–12:00
Address
Hans Edvard Teglers Vej 9, 1st floor · 2920 Charlottenlund
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