Early Barrett esophagus-related neoplasia in segments 1 cm or longer is always associated with intestinal metaplasia

Allanson, Benjamin; Mirzai, Bob; Khor, Tze Sheng; Raftopoulos, Spiro; Boer, W. Bastiaan de; Brown, Ian; Kumarasinghe, Marian Priyanthi

doi:10.1038/modpathol.2017.36

Cited by 9 publications

(4 citation statements)

References 27 publications

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“…While there have been studies showing that some oesophageal adenocarcinomas arise in the absence of intestinal metaplasia (IM), 7,8 there are other studies showing that virtually all high-grade dysplasia and adenocarcinomas are associated with IM. 9,10 According to American and Australian Guidelines, CLO without IM alone is not considered as an indication for surveillance, as it does not satisfy the diagnostic criteria for a diagnosis of Barrett's oesophagus. However, due to concern over sampling and some small studies suggesting equal risk with CLO, 8,11,12 current British guidelines do not require IM for a diagnosis of Barrett's oesophagus, and recommend surveillance in all patient with intestinal metaplasia or CLO ≥3 cm.…”

Section: Non-neoplastic Barrett's Oesophagusmentioning

confidence: 99%

“…Intestinal‐type metaplastic mucosa is biologically unstable, with the greatest risk of neoplastic progression through dysplasia to adenocarcinoma. While there have been studies showing that some oesophageal adenocarcinomas arise in the absence of intestinal metaplasia (IM), 7,8 there are other studies showing that virtually all high‐grade dysplasia and adenocarcinomas are associated with IM 9,10 …”

Section: Non‐neoplastic Barrett’s Oesophagusmentioning

confidence: 99%

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The modern management of Barrett’s oesophagus and related neoplasia: role of pathology

et al. 2020

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Modern management of Barrett’s oesophagus and related neoplasia essentially focuses upon surveillance to detect early low‐risk neoplastic lesions and offering organ‐preserving advanced endoscopic therapies, while traditional surgical treatments of oesophagectomy and lymph node clearance with or without chemoradiation are preserved only for high‐risk and advanced carcinomas. With this evolution towards figless invasive therapy, the choice of therapy hinges upon the pathological assessment for risk stratifying patients into those with low risk for nodal metastasis who can continue with less invasive endoscopic therapies and others with high risk for nodal metastasis for which surgery or other forms of treatment are indicated. Detection and confirmation of neoplasia in the first instance depends upon endoscopic and pathological assessment. Endoscopic examination and biopsy sampling should be performed according to the recommended protocols, and endoscopic biopsy interpretation should be performed applying standard criteria using appropriate ancillary studies by histopathologists experienced in the pathology of Barrett’s disease. Endoscopic resections (ERs) are both diagnostic and curative and should be performed by clinicians who are skilled with advanced endoscopic techniques. Proper preparation and handling of ERs are essential to assess histological parameters that dictate the curative nature of the procedure. Those parameters are adequacy of resection and risk of lymph node metastasis. The risk of lymph node metastasis is determined by depth invasion and presence of poor differentiation and lymphovascular invasion. Those adenocarcinomas with invasion up to muscularis mucosae (pT1a) and those with superficial submucosal invasion (pT1b) up to 500 µ with no poor differentiation and lymphovascular invasion and negative margins may be considered cured by endoscopic resections.

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Section: Non-neoplastic Barrett's Oesophagusmentioning

confidence: 99%

Section: Non‐neoplastic Barrett’s Oesophagusmentioning

confidence: 99%

The modern management of Barrett’s oesophagus and related neoplasia: role of pathology

et al. 2020

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“…41,42 Instead of focusing on the epithelium directly adjacent to early esophageal adenocarcinomas, investigators looking for any intestinal metaplasia in endoscopic mucosal resection specimens have typically found it. 43,44 Allanson and colleagues recently reported intestinal metaplasia in 79% of 139 such specimens. Including intestinal metaplasia found in previous or subsequent specimens, the frequency was 86%.…”

Section: Differing Viewpoints On the Requirement Of Intestinal Metaplmentioning

confidence: 99%

Gastrointestinal pathologists’ perspective on managing risk in the distal esophagus: convergence on a pragmatic approach

Bellizzi

Hafezi-Bakhtiari

Westerhoff

et al. 2018

Annals of the New York Academy of Sciences

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Here, we discuss recent updates and a continuing controversy in the diagnosis and management of Barrett's esophagus, specifically the recommendation that the irregular Z-line not be biopsied, the diminished status of ultrashort-segment Barrett's esophagus, the evidence basis for excluding and including the requirement of goblet cells for the diagnosis of Barrett's esophagus, and the conclusion that histologically confirmed low-grade dysplasia is best managed with endoscopic ablation rather than surveillance. We reference the American Gastroenterological Association and College of Gastroenterology and the British Society of Gastroenterology guidelines throughout, with the thesis that the field is converging on the concept of applying scarce medical resources to the diagnosis, surveillance, and therapy of patients most likely to derive benefit.

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“…[1][2][3][4][5][6] Esta condición constituye un factor de riesgo de gran importancia en el desarrollo de ACE, debido al riesgo de progresión metaplasia -displasia -carcinoma. [7][8][9][10][11][12] Los factores de riesgo asociados al EB son la edad (mayor a 50 años), el sexo (masculino), la presencia de RGE crónico o mayor a 5 años y obesidad central. 2,3,6,13 Los factores de riesgo asociados a la progresión del EB hacia displasia/ACE son la edad avanzada, longitud de EB > 3 cm, obesidad central y TBQ.…”

Section: Introductionunclassified

Prevalencia de esófago de Barrett en lengüetas menores a 1 cm

Quirán¹,

Manzotti²,

Tawil³

et al. 2020

Acta gastroenterol. latinoam.

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Introduction. Barrett Esophagus is an acquired condition secondary to gastroesophageal reflux disease, and it´s the main risk factor for Esophageal Adenocarcinoma. Although there is controversy about tissue sampling at endoscopy when segments are lesser than 10 mm, the prevalence of ultrashort Barrett´s esophagus is up to 20%. Objective. To estimate ultrashort Barrett Esophagus prevalence in a poblational cohort of Argentina and to assess the presence of dysplasia. Methods. A cross-sectional study of the endoscopic and pathological reports of ultrashort Barrett suspicion in an outpatient endoscopy center was performed during 2016-2017. 894 patients were enrolled. Results. 52% of the cohort were male, whose mean age was 56 years (± 12 years). Average Body Mass Index was 26 ± 4 kg/m2. Endoscopically, 50% had hiatal hernia and mean length was 2.32 ± 0.59 cm. Virtual chromoendoscopy was applied in 60% of patients. Ultrashort Barrett´s Esophagus prevalence was 25% (IC 95%), 224/894 patients. Median length was 0.74 ± 0.24 cm. Male sex and presence of hiatal hernia showed a statistically significant association with ultrashort BE presence in multivariate analysis. Conclusion. Ultrashort BE was identified in 25% of the patients, being more frequent in male sex and in patients with hiatal hernia; two variables that are independently related to intestinal metaplasia. Dysplasia was not observed.

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Early Barrett esophagus-related neoplasia in segments 1 cm or longer is always associated with intestinal metaplasia

Cited by 9 publications

References 27 publications

The modern management of Barrett’s oesophagus and related neoplasia: role of pathology

The modern management of Barrett’s oesophagus and related neoplasia: role of pathology

Gastrointestinal pathologists’ perspective on managing risk in the distal esophagus: convergence on a pragmatic approach

Prevalencia de esófago de Barrett en lengüetas menores a 1 cm

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