Barrett's esophagus. Practical issues for daily routine diagnosis

Diagnosis and Management of Barrett’s Esophagus with and Without Dysplasia

“…Clinically relevant diagnostic categories, include negative for dysplasia, indefinite for dysplasia, positive for dysplasia (either LGD or HGD), intramucosal adenocarcinoma (IMC), and invasive adenocarcinoma, which correspond to the Vienna classification of gastrointestinal epithelial neoplasia [65]. The term "dysplasia" is still used more widely than intraepithelial neoplasia [66]. In the 2000 WHO classification the term "dysplasia" was deserted for lesions which are characterized by morphological changes resulting from clonal alterations in genes and which carry a predisposition for progression [67].…”

Barrett-Neoplasie: Wo liegt eigentlich das Problem?

“…Im Hinblick auf die aktuelle Diskussion, die vor allem durch die Arbeit unserer Gruppe 2009 weiter angestoßen wurde, und eine Arbeit aus Boston, in der gezeigt werden konnte, dass Zylinderepithelsegmente des Ösophagus mit und ohne Becherzellen ähnliche DNA-Veränderungen aufweisen, muss man sagen, dass der Konsens von 2003 der Deutschen Gesellschaft für Pathologie sehr weitsichtig war [6][7][8][9][10]. In der Zwischenzeit wurde durch die Montreal-Klassifikation und die unter Mitarbeit unserer Arbeitsgruppe erstellte PragKlassifikation deutlich, dass der Barrett-Ösophagus sich immer weiter zu einer endoskopischen Diagnose entwickelte und die Histologie mittlerweile eher bestätigend eine intestinale Metaplasie nachweist [11,12] (l " Abb. 1).…”

Discrepancies and pitfalls in diagnosis and therapy of esophageal columnar metaplasia/Barrett's esophagus: A personal view

“…). The metaplastic columnar mucosa often but not always resembles intestinal metaplasia with goblet cells as the key histological marker . Intestinal metaplasia in the esophagus should not be confused with that in the cardia, which is not uncommon …”

“…It is my distinct impression that not uncommonly very short or ultra‐short BE is erroneously confused with the upper cardia. Documentation of intestinal metaplasia with goblet cells, as required in the American guidelines for the diagnosis of BE, is not absolutely necessary for various reasons, such as the occasional absence of intestinal metaplasia, especially in short segment metaplasia, or the development of neoplastic change without adjacent intestinal metaplasia …”

“…Documentation of intestinal metaplasia with goblet cells, as required in the American guidelines for the diagnosis of BE, is not absolutely necessary for various reasons, 3 such as the occasional absence of intestinal metaplasia, especially in short segment metaplasia, or the development of neoplastic change without adjacent intestinal metaplasia. 1 The importance of recognizing BE relates to the precancerous significance of metaplastic mucosa although the risk appears lower than that indicated in the past. 9 The low risk figures are perhaps related to the widespread use of acid suppressants.…”