Barrett's Esophagus Segment Length Research Articles

Significance of Crypt Atypia in Barrett’s Esophagus: A Clinical, Molecular, and Outcome Study

The aim of this study was to characterize baseline morphologic features of crypts in nondysplastic Barrett's esophagus and correlate them with DNA content abnormalities and risk of progression to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC). The morphologic features of nondysplastic crypts in baseline biopsy specimens from 212 BE patients (2956 biopsy specimens) were graded histologically using a 4-point scale (crypt atypia levels, 0-3). DNA content abnormalities were detected using flow cytometry. In patients who had dysplasia in their baseline biopsy specimens, dysplasia was associated significantly with increasing grades of crypt atypia in the background nondysplastic Barrett's esophagus (P < .001). In a subset of patients without dysplasia at baseline (N= 149), a higher grade of crypt atypia was associated with longer Barrett's esophagus segment length (5.5 vs 3.3 cm; P= .0095), and a higher percentage of cells with 4N DNA content (3.67 ± 1.27 vs 2.93 ± 1.22; P= .018). Crypt atypia was associated with the development of any neoplasia (low-grade dysplasia and HGD/EAC). Although no significant association was noted between the grade of crypt atypia and increased 4N, aneuploidy, or progression to HGD/EAC, only patients with grade 2 or 3 crypt atypia showed increased 4N, aneuploidy, or progression to HGD/EAC. Patients with Barrett's esophagus likely develop dysplasia via a progressive increase in the level of crypt atypia before the onset of dysplasia, and these changes may reflect some alteration of DNA content.

Negative surveillance endoscopy occurs frequently in patients with short-segment non-dysplastic Barrett's esophagus.

Surveillance endoscopy of non-dysplastic Barrett's esophagus (NDBE) that fails to detect intestinal metaplasia (IM), or negative surveillance, is known to occur in clinical practice, although the frequency and possible outcomes in a large cohort in clinical practice is not well described. The goals of this study were to define frequency in which negative surveillance occurs and endoscopic outcomes in a screening cohort of short segment NDBE. A retrospective cohort (n = 184) of patients newly diagnosed with short segment NDBE at an outpatient academic tertiary care center between 2003 and 2011 were reviewed. Only those with one or more surveillance endoscopies were included to define a frequency of negative surveillance. Included patients were further assessed if they had two or more surveillance endoscopies and were classified into groups as sampling error or negative IM on consecutive surveillances based on the results of their surveillance endoscopies. The frequency of a negative surveillance endoscopy in all short-segment NDBE patients was 19.66% (92 endoscopic exams were negative for IM of 468 total surveillance exams). A negative surveillance endoscopy occurred in 40.76% (n = 75) patients. Sampling error occurred in 44.12% and negative IM on consecutive surveillance endoscopies in 55.88% of those with ≥ 2 surveillance endoscopies and an initially negative surveillance exam. The frequency of negative IM on consecutive surveillances was 19.00% of all patients who had two surveillance endoscopies. When the index diagnostic Barrett's esophagus segment length was < 1 cm, 32.14% (18/56) of all patients (with ≥ 2 surveillance endoscopies) had negative IM on consecutive surveillance endoscopies. Negative surveillance occurs frequently in short-segment NDBE. When an initial negative surveillance endoscopy occurs, it may be due to either a sampling error or lack of detectable IM on surveillance exam. When a <1 cm segment of NDBE is diagnosed, a significant proportion of patients may go on to have continuously undetected IM on consecutive surveillance endoscopic exams without intervention.

Temporal Change in Barrett's Esophagus Segment Length (BESL) During Prospective Surveillance

Background: Few studies have explored changes in BESL during prospective endoscopic surveillance. The aim of this study was to investigate BESL changes during prospective surveillance and factors contributing to BESL change. Methods: Endoscopic landmarks were followed prospectively in 467 patients for an average of 5 years and changes in BESL were monitored at well-defined endoscopic intervals and recorded in a database. Individuals with BESL change outside of the expected statistical variation during follow-up were further analyzed for contributing patient and environmental factors. Results: 79 of the 467 patients (17%) had significant change in BESL during follow-up whereas the BESL remained stable in 338 patients (83%). There was no statistical difference in BESL changes between males and females (two tail t-test p >0.2). There was also no significant difference between rates of BESL change for those patients who were followed for <2 years compared to those followed for >6 years. No significant changes occurred in the BESL rate of change as a function of baseline segment length. Total regression of the BE segment was significantly associated with a smaller hiatal hernia (p<0.0001). Additionally, the mean baseline BESL of those patients who had total regression of their BE segment was significantly shorter as compared to patients without complete regression (2.4cm vs. 5.8cm; p<0.001). However, there was no significant difference in hiatal hernia size among patients whose BESL increased, remained stable, or decreased. There was a significant association between the duration of PPI use and the rate of decrease of BESL (p trend = 0.027). Conclusions: (1) Most BESLs remain stable during prospective follow-up. (2) Smaller hiatal hernia and shorter baseline BESL increase a patient's likelihood of complete regression of BE. (3) Extended treatment with PPIs appears to contribute to decreased BESL. (4) Patient gender and the length of follow-up do not seem to affect the rate of change of a Barrett's segment length.