Comprehensive Cancer Centre Amsterdam Barrett Advisory Committee: first results.
BACKGROUND
Treatment and follow-up policy for Barrett's oesophagus are dependent on the grade of dysplasia. However, sampling error of random biopsy protocols and subjectivity of pathological grading may hamper endoscopic surveillance.


METHODS
The Amsterdam Comprehensive Cancer Center Barrett Advisory Committee (BAC) is a regional multidisciplinary consultative working-group, offering revision of pathology, revision of pathology plus additional endoscopic diagnostics, or referral for treatment.


RESULTS
Between July 1998 and July 1999 30 patients were referred to the B.A.C for advice; eighteen patients were referred because of suspicion of high grade dysplasia. Reassessment of biopsies, including additional quantitative pathology, with or without additional endoscopic diagnostics, led to adjustment of the grading of dysplasia in 15 patients (50%). A suspicion of low grade dysplasia was rejected in nine out of ten cases. Adjustment of the original diagnosis often influenced further therapy or follow-up.


CONCLUSIONS
reassessment of conventional pathology, quantitative pathology, and additional diagnostic procedures might improve the accuracy of diagnosis and staging of malignant degeneration of Barrett's oesophagus, although experience is still limited. The complexity of the management of these patients demands a specialised multidisciplinary approach. A Barrett Advisory Committee can offer valuable contributions to the treatment of patients with Barrett's oesophagus.
Hulscher
J B
JB
Department of Surgery and Gastroenterology, Academic Medical Center/University van Amsterdam, Afdeling Chirurgie, G4-134, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. j.b.hulscher@amc.uva.nl
Haringsma
J
J
Benraadt
J
J
Offerhaus
G J
GJ
ten Kate FJ
Baak
J P
JP
Tytgat
G N
GN
van Lanschot JJ
D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D001707:Biopsy, Needle; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012017:Referral and Consultation; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012955:Societies, Medical