Current diagnosis of Barrett's oesophagus: An analysis of 1000 histologically confirmed 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. Patients and 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. Conclusion: 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.