Comparisons of endoscopic and pathological characteristics between long and short segment Barrett's esophagus
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Objective To investigate the similarities and differences of endoscopic and pathological char- acteristics between long and short segment Barrett's esophagus.Methods One hundred and twenty-eight cases of Barrett's esophagus identified both by endoscopy and pathology were enrolled in this retrospective study. Among them,40 cases were long segment Barrett's esophagus (LSBE) and 88 were short segment Barrett's esophagus (SSBE).The age distribution,sex distinction,endoscopic manifestations and pathological changes were assessed.Data were statistically analyzed by t-test or u-test.Results There were no differences in age distribution and sex distinction between LSBE and SSBE groups (P＞0.05).The ring pattern was the most prominent type accounting for 62.5% in LSBE group.The island pattern was the most prominent type accounting for 85.2% in SSBE group.There were significant differences in the rates of specialized intestinal metaplasia between LSBE and SSBE groups(47.5% vs 14.8%,P＜0.01).Moreover,among the special- ized intestinal metaplasia,low grade (15.0% vs 4.5%),medium grade (12.5% vs 3.4%) and high grade dysplasia (5.0% vs 0.0%) between LSBE and SSBE groups also had statistical differences (all P＜0.05).Conclusions LSBE may have more tendency in dysplasia than that of SSBE.We should pay attention to the importance of endoscopic manifestations and pathological diagnosis.Keywords:
Intestinal metaplasia
Barrett's esophagus
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Barrett's esophagus is associated with adenocarcinoma of the cardia and esophagus, regardless of its extent. The aim of this study was to compare the prevalence and incidence of dysplasia and adenocarcinoma in short segment and traditional long segment Barrett's esophagus.Seventy-four patients with short segment Barrett's and 78 with traditional Barrett's entered the study.There were no significant differences in age or gender between the two groups of patients with Barrett's esophagus. A greater percentage of patients with short segment barrett's were black (p = 0.04). The prevalence of dysplasia at diagnosis in patients with short segment Barrett's was 8.1% versus 24.4% in patients with traditional Barrett's (p < 0.007). Adenocarcinoma was noted at diagnosis only in patients with traditional Barrett's (p < 0.0005). Twenty-six patients with short segment Barrett's and 29 with traditional Barrett's were followed prospectively for 12-40 months. Dysplasia developed during follow-up in two patients with short segment Barrett's and in six patients with traditional Barrett's (p < 0.05). Neither high grade dysplasia nor cancer developed in any patients with short segment Barrett's. High grade dysplasia did develop in two patients with traditional Barrett's esophagus, and mucosal adenocarcinoma developed in one. The frequency of dysplasia on the latest surveillance examination continued to be significantly higher for patients with traditional Barrett's (p = 0.03). Follow-up surveillance biopsy specimens of Barrett's mucosa frequently demonstrated an absence of goblet cells in patients with short segment Barrett's compared with patients with traditional Barrett's (p < 0.0001).The prevalence of dysplasia or adenocarcinoma and the incidence of dysplasia in patients with traditional Barrett's esophagus are significantly higher than in patients with short segment Barrett's esophagus. Further prospective surveillance is required to determine whether the incidence of adenocarcinoma in patients with short segment Barrett's esophagus is significantly lower.
Barrett's esophagus
Intestinal metaplasia
Esophageal disease
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The designated area of the columnar-lined esophagus (CLE) is anatomically defined by the distal limit of the lower esophageal palisade vessels (LEPV) and the term 'Barrett's esophagus' is equally used along with the name CLE in Japan. The aim of this study was to investigate the actual prevalence of CLE based on the Japanese criteria and to evaluate the criteria per se. A total of 42 esophagi consecutively resected at this institute were included. All subjects underwent a surgical resection for squamous cell carcinoma of the esophagus. The position of the LEPV, squamocolumnar junction, the prevalence of CLE and intestinal metaplasia were investigated both pre- and postoperatively. Preoperative endoscopy revealed CLE based on the Japanese criteria in half of all patients. In the resected specimens the distal limit of LEPV was lower than the squamocolumnar junction in 95.2%. In other words, almost all cases had CLE (equivalent to Barrett's mucosa in Japanese criteria). However, most of the CLE areas were very short and their average maximum length was only about 5 mm. In addition, no intestinal metaplasia was observed in any of the CLE cases. Almost all individuals might therefore be diagnosed to have CLE or Barrett's mucosa based on precise endoscopic observations in Japan. The CLE located in a small area, e.g. less than 5 mm, defined according to the LEPV criteria without any other factor concerning typical Barrett's esophagus such as signs of gastroesophageal reflux should therefore be excluded from consideration as a high-risk mucosa.
Intestinal metaplasia
Barrett's esophagus
Metaplasia
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Barrett's esophagus
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Objective To investigate the endoscopic and clinico-pathological characteristics in patients with Barrett esophagus in China.Methods Using the terms ofBarrett's esophagusandBarrett's esophagus,china as ,literatures published in Chinese and English journals were searched by Chinses data banks and MEDLINE from 1989 to 2007.An analysis was carried out with the standard inclusion and exclusion criteria.Results Four thousand one hundred and thirty two cases were included in this study.① BE was found in 2.39% of patients undergoing endoscopy for various symptoms of upper gastrointestinal tract diseases.Male and female were in the ratio of 2.08∶1 and the average age of onset was 53.27 years.And 51% of patients with BE occurred specific symptoms for gastroesophageal reflux disease(GERD).② The island-type Barrett esophagus was predominant,about 56.81%.The incidence of BE with special intestinal metaplasia was 36.58%,but the special intestinal metaplasia was more common in tongue-type BE than that in island-type and circumferential-type(both P0.001),and it was more observed in long segment BE than that in short segment esophagus(P0.001).③ The mean length of follow-up was 2 years in 492 patiens.The incidence of adenocarcinoma was 0.61%.Conclusion In China,the endoscopic incidence of Barrett esophagus is lower than that in Western countries,but the average age of onset is younger.There is an approximate value of the incidence of BE developing adenocarcinoma between Chinese and Westerners.Similarily to reports from Western countries,BE is more frequent in male than in female,about half patients have no specific symptoms of GERD,the tongue-type and the long segment Barrett esophagus are apt to special intestinal metaplasia.
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We evaluated the risk of adenocarcinoma developing in Barrett's esophagus (esophagus lined with columnar epithelium). Mayo Clinic records were reviewed, and all cases that met predefined histologic criteria for the diagnosis of Barrett's esophagus in 1979 or earlier were included. In 18 of 122 such cases, adenocarcinoma of the esophagus and Barrett's esophagus were diagnosed simultaneously. The status of the remaining 104 cases was determined after a mean interval of 8.5 years. During this time, adenocarcinoma of the esophagus developed in 2 patients, and 24 died from other causes. We conclude that although the incidence of esophageal adenocarcinoma is increased in patients with symptomatic Barrett's esophagus, it does not occur in the majority of such patients. (N Engl J Med 1985; 313: 857–9.)
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Esophageal adenocarcinoma
Esophageal disease
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Barrett's esophagus
Esophageal adenocarcinoma
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Oncologic screenings of the populations in the areas with increased incidence of esophageal cancer have revealed Barrett's ulcer in 1 percent of the examinees. Endoscopic and cytologic characteristics of this condition are presented. Precancer changes--severe dysplasia--are most frequent in male Kazakhs (14.1 percent) aged 50 to 59 (14.7 percent). Subjects with Barrett's ulcer developing severe dysplasia, as evidenced by cytograms, should be included in the group of subjects at risk for carcinoma of the lower third of the esophagus and cardia.
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Barrett's esophagus is defined as intestinal metaplasia in columnar mucosa of the esophagus from endoscopic mucosal biopsy. Barrett's esophagus is a complication of gastroesophageal reflux disease and is the leading cause of esophageal adenocarcinoma. According to recent data, the annual incidence of low grade dysplasia, high grade dysplasia, and adenocarcinoma in patients with Barrett’s esophagus were 3.6%, 0.48%, and 0.27%, respectively. Annual incidence of esophageal adenocarcinoma in patients with low grade dysplasia is 0.6%, and that in high grade dysplasia is 5.6%. Endoscopic surveillance of Barrett’s esophagus should be performed with the purpose of detecting dysplasia and adenocarcinoma. Endos-copic surveillance of Barrett's esophagus is recommended at an interval of 2∼5 years, and if low grade dysplasia develops, then follow up endoscopy should be done at 2 months to 1 year interval. If high grade dysplasia is detected, then it should be resected endoscopically. Biopsy for detection of Barrett’s esophagus is recommended as a random four quadrant biopsy of 2 cm intervals in the columnar metaplasia. However, due to the relatively low incidence of esophageal adenocarcinoma, low cost of endoscopic examination, and frequent endoscopic examination due to country-based gastric cancer surveillance program in our country, the foreign guideline of Barrett’s esophagus should be adjusted to our circumstance. (Korean J Helicobacter Up Gastrointest Res 2012;12:67-70)
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The standard for classifying Barrett's metaplasia on endoscopy, the Prague C&M criteria, ignores all islands of metaplastic-appearing tissue. The aims of the present study were to measure the prevalence of columnar islands, quantify their impact on metaplasia extent, and determine if they harbor advanced dysplasia.Data from two prospective patient cohorts were retrospectively analyzed. They included adults who underwent upper endoscopy to evaluate for gastroesophageal reflux disease, Barrett's esophagus (BE), dysplasia, or adenocarcinoma between 2003 and 2012 at tertiary care centers in the USA and Germany. The BE pattern, location, and pathology were examined. The extent of BE as defined by the Prague criteria (disregarding the location of islands) was compared with the complete maximal extent of BE (incorporating the location of islands).A total of 555 patients underwent endoscopy (mean age 60.1 years, 67.2% male, 91.9% white). Among those patients, 191 (34.4%) showed metaplastic-appearing mucosa in islands. Endoscopically, in 101 (52.9%) cases, islands were proximal to the farthest segment of BE as defined by the Prague M location. Histologically, intestinal metaplasia was confirmed in 60 (58.8%) of the 102 esophagogastroduodenoscopies (EGDs) where islands were biopsied. In 41 (40.2%) cases, the histologically confirmed BE islands extended farther than the maximal segment based on the Prague criteria. Pathology from biopsies of islands either changed the diagnosis or worsened the BE dysplasia grade in 16 (15.7%) of the 102 patients.Columnar islands are commonly seen on EGD. The Prague C&M criteria may underestimate the maximal extent of BE and overlook the area of highest dysplasia grade.
Intestinal metaplasia
Barrett's esophagus
Metaplasia
Squamous metaplasia
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Barrett's esophagus
Intestinal metaplasia
Hiatal Hernia
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