Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Quality of Barrett's surveillance in The Netherlands: a standardized review of endoscopy and pathology reports

Curvers, Wouter L.a b; Peters, Femke P.a b; Elzer, Brendab; Schaap, Annet J.C.M.b; Baak, Lubbertus C.a d; van Oijen, Arnouda e; Mallant-Hent, Rosalie M.a f; ten Kate, Fieboa c; Krishnadath, Kausilia K.a b; Bergman, Jacques J.G.H.M.a b

European Journal of Gastroenterology & Hepatology: July 2008 - Volume 20 - Issue 7 - p 601-607
doi: 10.1097/MEG.0b013e3282f8295d
Original Articles: Oesophageal and Gastric Disorders

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.

Materials and 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.

Conclusion 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.

aAmsterdam Gastroenterological Association

Departments of bGastroenterology and Hepatology

cPathology, Academic Medical Centre

dDepartment of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam

eDepartment of Gastroenterology and Hepatology, Medical Centre Alkmaar, Alkmaar

fDepartment of Internal Medicine, Flevo Hospital, Almere, The Netherlands

Correspondence to Jacques J.G.H.M. Bergman, Department of Gastroenterology and Hepatology, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

Tel: +31 20 5663556; e-mail:

Data presented previously at DDW 2007 in Washington and published as an abstract in Gastroenterology 2007; 132 (Suppl 2):A640.

Received 13 November 2007 Accepted 13 January 2008

© 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins