[The status of diagnosis of Barrett esophagus. An analysis of 1000 histologically diagnosed cases].
OBJECTIVE
To evaluate the quality of diagnosis in cases of Barrett's oesophagus (BOe). It was examined whether: (1) there had been regular pre-treatment investigations;(2) characteristic mucosal changes had been recognized by endoscopy; (3) a diagnosis of intraepithelial neoplasia had been made more often than of advanced Barrett carcinoma.


METHODS
Endoscopic and associated bioptic reports on 1000 consecutive patients with histologically confirmed BOe, seen between 1990 and 1995, were analysed. (Average age was 63 +/- 14.3 years; male to female ratio: 2.2:1).


RESULTS
In 85.1% of patients the histological diagnosis was BOe without dysplasia. The neoplasias consisted of carcinoma in 8.8%, suspected carcinoma in 0.5%, actual or suspected low-grade dysplasia in 4.6%, actual or high-grade dysplasia in 1.0%. Endoscopic diagnosis in cases without neoplasia was in 60.8% correct for actual BOe or suspected BOe. At endoscopy dysplasia was suspected in 5.4%. The diagnosis or suspected diagnosis of Barrett's carcinoma was correct in 69%. Repeat endoscopy a year after the initial diagnosis was performed in 9.4% with BOe and no neoplasia. Repeat endoscopy was performed in 37.5% of patients with an initial diagnosis of suspected low-grade dysplasia, in 43.3% with low-grade dysplasia, in 42.9% of suspected high-grade and in 100% of actual high-grade dysplasia.


CONCLUSIONS
Neoplasia in Barrett's oesophagus is found too late. Only half of the histologically confirmed cases are found by endoscopy and follow-up is not sufficient.
Grunewald
M
M
Institut für Pathologie, Klinikums Bayreuch. lkpathol@patho-pc.med.uni-erlangen.de
Vieth
M
M
Kreibich
H
H
Bethke
B
B
Stolte
M
M
D000368:Aged; D001471:Barrett Esophagus / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D001706:Biopsy; D002277:Carcinoma / Q000175:diagnosis* / Q000209:etiology; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000209:etiology; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
Untersuchungen zum Stand der Diagnostik des Barrett-Osophagus. Eine Analyse von 1000 histologisch diagnostizierten Fällen.