Location of dysplasia and cancer in patients with Barrett's esophagus

Abstract

Surveillance of patients with Barrett's esophagus is undertaken for the detection of dysplasia and adenocarcinoma. This involves obtaining random biopsies from the entire Barrett's segment. The preferential location of dysplasia/cancer either proximally or distally within the Barrett's segment in not clear and if clarified may assist in surveillance programs. Aim: To determine the location of dysplasia/cancer in patients with Barrett's esophagus. Methods: Patients with Barrett's esophagus (2=:3cms length) diagnosed with low grade dysplasia (LGD), high grade dysplasia (HGD) or cancer (CA) were identified from a well defined prospectively followed group of patients with Barrett's esophagus all having undegone a similar biopsy protocol-4 quadrant, every -2 cms. The location of biopsies revealing dysplasia/cancer in these patients was classified as proximal/distalif dysplasia/cancer were diagnosed in biopsy specimens from both proximal & distal Barrett's segments; distal only -dysplasia/cancer only in the distal biopsy specimens; proximal only -dysplasia/cancer only in the proximal biopsy specimens. The patient demographics and the length of Barrett's were also recorded. Results: Sixty-five patients (all white males) with Barrett's esophagus and LGD,HGD,and/or CA were studied; mean age 61.4 years (range:30-80 yrs), mean Barrett's length 7.7 ems (range:3-19 cms) These patients have undergone a total of 198 EGDlbx sessions revealing dysplasia/cancer. Location of dysplasia/cancer is as follows (table): Conclusions: Dysplasia, including HGD and CA is distributed throughout the entire length of the segment (ie.both proximally & distally) in more than half of patients with dysplasia/cancer within Barrett's esophagus thus necessitating the need for surveillance biopsies from the entire Barrett's esophagus. The concept that cancer occurs distally in patients with Barrett's esophagus is probably incorrect.