Comprehensive Cancer Centre Amsterdam Barrett Advisory Committee: first results

Background: Treatment and follow-up policy for Barrett's oesophagus are dep endent on the grade of dysplasia. However, sampling error of random biopsy protocols and subjectivity of pathological grading may hamper endoscopic su rveillance. Methods: The Amsterdam Comprehensive Cancer Center Barrett Advi sory Committee (BAC) is a regional multidisciplinary consultative working-g roup. offering revision of pathology, revision of pathology plus additional endoscopic diagnostics, or referral for treatment. Results: Between July 1 998 and July 1999 30 patients were referred to the B.A.C for advice; eighte en patients were referred because of suspicion of high grade dysplasia. Rea ssessment of biopsies. including additional quantitative pathology, with or without additional endoscopic diagnostics, led to adjustment of the gradin g 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 of ten influenced further therapy or follow-up. Conclusions. Reassessment of c onventional pathology, quantitative pathology, and additional diagnostic pr ocedures might improve the accuracy of diagnosis and staging of malignant d egeneration of Barrett's oesophagus, although experience is still limited. The complexity of the management of these patients demands a specialised mu ltidisciplinary approach. A Barrett Advisory Committee can offer valuable c ontributions to the treatment of patients with Barrett's oesophagus. (C) 20 01 Elsevier Science B.V. All rights reserved.