Quality of Barrett's surveillance in The Netherlands: a standardized review of endoscopy and pathology reports.
OBJECTIVE
The quality of Barrett's surveillance relies on an adequate endoscopic inspection, obtaining a sufficient number of biopsy specimens, good communication of the endoscopic findings to the pathologist, and an accurate description of the histological findings by the pathologist. The aim of this study was to assess the quality of Barrett's surveillance in daily practice in The Netherlands.


METHODS
A structured scoring list was developed to evaluate systematically the quality of endoscopy and pathology reports. From 15 hospitals, endoscopy reports and corresponding pathology reports were selected randomly and evaluated by two observers. In case of disagreement, the observers re-evaluated the reports in a consensus meeting.


RESULTS
One hundred and fifty cases were evaluated. The adherence to current standard biopsy protocols (four quadrant biopsies every 2 cm) decreased with increasing Barrett's length: 0-5 cm: 79%; 5-10 cm: 50%; 10-15 cm: 30%. The indication for the endoscopy was mentioned in 28% of the pathology reports, in 4% the presence/absence of oesophagitis was communicated, and in 19% the location and/or aetiology of biopsies was described. The presence/absence of dysplasia was mentioned in 93% of pathology reports.


CONCLUSIONS
Endoscopy reports and pathology reports in current practice do not include all relevant information for an adequate Barrett's surveillance. In short Barrett's oesophagus, the adherence to current standard biopsy protocols is acceptable, but in longer segments (with a higher risk for neoplastic progression) this is clearly insufficient. The communication between endoscopists and pathologist is suboptimal.
Curvers
Wouter L
WL
Amsterdam Gastroenterological Association, Academic Medical Centre, Amsterdam, The Netherlands.
Peters
Femke P
FP
Elzer
Brenda
B
Schaap
Annet J C M
AJ
Baak
Lubbertus C
LC
van Oijen
Arnoud
A
Mallant-Hent
Rosalie M
RM
Ten Kate
Fiebo
F
Krishnadath
Kausilia K
KK
Bergman
Jacques J G H M
JJ
D000230:Adenocarcinoma / Q000473:pathology*; D001471:Barrett Esophagus / Q000473:pathology*; D001706:Biopsy; D003142:Communication; D004938:Esophageal Neoplasms / Q000473:pathology*; D004945:Esophagoscopy / Q000592:standards; D005260:Female; D006302:Health Services Research / Q000379:methods; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008499:Medical Records / Q000592:standards; D008875:Middle Aged; D009426:Netherlands; D011159:Population Surveillance / Q000379:methods*; D011230:Precancerous Conditions / Q000473:pathology*; D011787:Quality of Health Care; D012189:Retrospective Studies