World Gastroenterology Organisation

Global Guardian of Digestive Health. Serving the World.


Barrett’s Dysplasia and Cancer Taskforce ‘BAD CAT’ Consensus Group.

The BADCAT group aims to produce evidence based guidelines for best clinical and cost effective management of High Grade Dysplasia and early mucosal cancer in Barrett’s oesophagus.

Barrett's oesophagus is one of the most common premalignant lesions in the world. The occurrence of high grade dysplasia (HGD) and early mucosal cancer in Barrett’s oesophagus is an important watershed in the progression of carcinogenesis. Eradication of HGD and early mucosal cancer leads to a very high cure rate whereas missing the consequential invasive cancer leads to a progression to incurable cancer.

Improved survival relies on early detection through endoscopic surveillance programmes. The success of this strategy relies on the fact that late stage premalignant lesions or very early cancers can be cured by intervention. Currently there is considerable controversy over which method is best: i.e. conventional open surgery or endotherapies (techniques involving endoscopy).

In addition, there are several new technologies that can specifically deal with this condition. Management of HGD and early mucosal cancer in Barrett’s has great national and international variance.

The BADCAT consensus is entirely supported by donations from professional bodies including:

  • World Gastroenterology Organisation
  • American College of Gastroenterology
  • American Gastroenterology Association
  • American Society of Gastrointestinal Endoscopy
  • Association of Upper GI Surgeons
  • British Society of Gastroenterology
  • Canadian Gastroenterology Society
  • Fight Oesophageal Reflux Together (FORT)
  • German Society of Endoscopy (DGE-BV)
  • International Society of Diseases of the Esophagus
  • International Working Group for Columnar
  • Oesophagus Oesophageal Cancer Fund (Ireland)
  • Royal College of Pathologists (Affiliation)
  • Netherlands Association of Hepatogastroenterologists

More than 60 clinicians and scientists, from at least 14 different countries are working in 10 separate disciplines to address distinct topics including routine pathology, molecular pathology, routine endoscopy, advanced endoscopy, cost economic modelling, epidemiology, medical therapy, endoscopic therapy, surgical therapy and patient support/consent.

The mechanism we are using involves carrying out a literature search and preparing evidence-based documents, presenting and voting on the iterations of these evidence-based statements, and ultimately forming a consensus.

At this point, we have finalized the literature searches,, begun selecting the relevant papers and initiated the process of writing draft statements. The first drafts will be ready for presentation at the BSG meeting in Liverpool (UK) 23rd March 2010. We aim to complete the process by the end of 2010.

We use web-based applications to work together, speeding up the process of selecting relevant citations from over 11 000 hits retrieved by electronic database searching. To reduce travel costs, we work together using internet teleconferencing, email and electronic voting. Special computer skills are not needed when using these applications, only access to the internet.

If you would like to join the BADCAT consensus group, please contact Professor Janusz Jankowski, the chair of the BADCAT consensus guideline group.


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