Short Barrett's Esophagus Research Articles

Racial Disparities in Adherence to Quality Indicators in Barrett's Esophagus: An Analysis Using the GIQuIC National Benchmarking Registry.

Racial disparities in outcomes in esophageal adenocarcinoma are well established. Using a nationwide registry, we aimed to compare clinical and endoscopic characteristics of blacks and whites with Barrett's esophagus (BE) and adherence to defined quality indicators. We analyzed data from the Gastrointestinal Quality Improvement Consortium Registry between January 2012 and December 2019. Patients who underwent esophagogastroduodenoscopy with an indication of BE screening or surveillance, or an endoscopic finding of BE, were included. Adherence to recommended endoscopic surveillance intervals of 3-5 years for nondysplastic BE and adherence to Seattle biopsy protocol were assessed. Multivariate logistic regression was conducted to assess variables associated with adherence. A total of 100,848 esophagogastroduodenoscopies in 84,789 patients met inclusion criteria (blacks-3,957 and whites-96,891). Blacks were less likely to have histologically confirmed BE (34.3% vs 51.7%, P < 0.01), had shorter BE lengths (1.61 vs 2.35 cm, P < 0.01), and were less likely to have any dysplasia (4.3% vs 7.1%, P < 0.01). Although whites were predominantly male (62.2%), about half of blacks with BE were female (53.0%). Blacks with nondysplastic BE were less likely to be recommended appropriate surveillance intervals (OR 0.78; 95% CI 0.68-0.89). Adherence rates to the Seattle protocol were modestly higher among blacks overall (OR 1.12, 95% CI 1.04-1.20), although significantly lower among blacks with BE segments >6 cm. The use of sex as a risk factor for BE screening may be inappropriate among blacks. Fewer blacks were recommended appropriate surveillance intervals, and blacks with longer segment BE were less likely to undergo Seattle biopsy protocol.

Comparative Outcomes of Cap Assisted Endoscopic Resection and Endoscopic Submucosal Dissection in Dysplastic Barrett’s Esophagus

Endoscopic resection is an important component of the endoscopic treatment of Barrett's esophagus (BE) with dysplasia and intramucosal adenocarcinoma. Endoscopic resection can be performed by cap-assisted endoscopic mucosal resection (cEMR) or endoscopic submucosal dissection (ESD). We compared the histologic outcomes of ESD vs cEMR, followed by ablation. We queried a prospectively maintained database of all patients undergoing cEMR and ESD followed by ablation at our institution from January 2006 to March 2020 and abstracted relevant demographic and clinical data. Our primary outcomes included the rate of complete remission of dysplasia (CRD): absence of dysplasia on surveillance histology, and complete remission of intestinal metaplasia (CRIM): absence of intestinal metaplasia. Our secondary outcome included complication rates. We included 537 patients in the study: 456 underwent cEMR and 81 underwent ESD. The cumulative probabilities of CRD at 2 years were 75.8% and 85.6% in the cEMR and ESD groups, respectively (P < .01). Independent predictors of CRD were as follows: ESD (hazard ratio [HR], 2.38; P < .01) and shorter BE segment length (HR, 1.11; P < .01). The cumulative probabilities of CRIM at 2 years were 59.3% and 50.6% in the cEMR and ESD groups, respectively (P > .05). The only independent predictor of CRIM was a shorter BE segment (HR, 1.16; P < .01). BE patients with dysplasia or intramucosal adenocarcinoma undergoing ESD reach CRD at higher rates than those treated with cEMR, although CRIM rates at 2 years and complication rates were similar between the 2 groups.

Prevalence and Predictors of NAFLD in a Population Based BE Cohort

Introduction: Central obesity, increased visceral abdominal fat and its sequelae such as metabolic syndrome and diabetes have been shown to be reflux independent risk factors for Barrett's esophagus (BE) and esophageal adenocarcinoma (EA). There are limited data prevalence and risk factors for non-alcoholic fatty liver disease (NAFLD) in BE subjects. Our aim was to assess the proportion of BE subjects in a population based BE cohort who had NAFLD and the predictors of NAFLD in those with BE. Methods: The Olmsted County BE cohort consists of all individuals with incident BE in Olmsted County, MN, from 1977 to 2014. All individuals with BE had histologic evidence of intestinal metaplasia and at least 1 cm of columnar mucosa in the tubular esophagus. The BE database was utilized to obtain additional demographic and clinical details. An initial NAFLD diagnosis was made using standard ICD9 and HICDA codes. The diagnosis was then confirmed by review of laboratory, radiology and/or histology reports. Those with evidence of substantial alcohol intake and/or hepatitis B or C infection were excluded. Logistic regression analysis was used to identify predictors of NAFLD. Results: The BE cohort consisted of 522 patients. Of these, 72 (13.8%) had a diagnosis of NAFLD. Table 1 presents baseline data of these cohorts. The diagnosis of NAFLD was made by radiologic studies (ultrasound, CT, or MRI) in the majority of subjects and by histology in one case. BE patients with NAFLD were more obese and had shorter BE segments than those without NAFLD (table 1). Multivariable regression modeling also confirmed this association (Table 2) adjusting for age and gender. The prevalence of dysplasia or cancer was not statistically different between these two cohorts.Table 1Table 2: Logistic Regression Models with outcome of NAFLDConclusion: In this retrospective study, 14% of BE subjects in a population based cohort from a midwestern US state had a clinical diagnosis of NAFLD. This may reflect an underestimate given lack of systematic screening for NAFLD in all BE subjects. BE subjects with NAFLD had a higher BMI and shorter BE segments than those without NAFLD.Figure 1Figure 2

Initial Treatment With Endoscopic Mucosal Resection Decreases the Incidence of Esophageal Adenocarcinoma in Patients With Barrettʼs, With High-Grade Dysplasia

Introduction: Endoscopic mucosal resection (EMR) is effective for the removal of nodular neoplastic mucosa in Barrett's esophagus (BE) with high grade dysplasia (HGD). While EMR is commonly performed prior to ablation, the impact of early EMR on the subsequent risk of esophageal adenocarcinoma (EAC) after radiofrequency ablation (RFA) is unknown. We compared outcomes of patients with HGD who had EMR then RFA to patients with HGD who had RFA alone. Methods: The U.S. RFA Registry is a study of RFA for BE at 148 centers. Patients were enrolled from 2007-2011 and followed prospectively until 2014. For inclusion in the current investigation, patients had HGD and were free from EAC at baseline. We compared HGD patients receiving EMR prior to RFA to HGD patients receiving RFA alone using Wilcoxon rank sum test for continuous variables and chi-square testing for categorical variables. Logistic regression models were constructed to assess odds ratios (OR) for EAC. Results: Among 5521 patients in the registry, 974 (18%) had HGD. Of these 974, 237 (24%) underwent EMR prior to RFA. Patients who underwent EMR prior to RFA did not differ from those who got RFA alone on age, race, gender, frequency of complete eradication of intestinal metaplasia (CEIM), or time in study, but did have shorter BE at baseline (4.7 vs 5.3 cm, p = 0.008) (Table). Amongst all patients with HGD, 83 (9%) developed EAC. Patients undergoing EMR prior to RFA were less likely to develop EAC (5% vs 10%, p = 0.03) or invasive EAC (2% vs 5%, p = 0.04). On logistic regression, after controlling for age, race, gender, BE length, and time in study, patients who did not undergo initial EMR had doubled odds of developing EAC (OR 1.9, 95% CI [1.01-3.6]). The impact of EMR on invasive EAC was similar in magnitude but did not reach significance after adjustment for the same factors (OR 2.7, 95% CI [0.94-7.7]). Conclusion: After controlling for multiple potential confounders, patients with HGD who received EMR prior to RFA were less likely to develop EAC than HGD patients treated with RFA alone. Since nodularity within BE is a risk factor for EAC, this finding is counter-intuitive. The performance of EMR may be a marker for closer mucosal inspection, leading to superior outcomes. Alternatively, facilities able to perform EMR may also perform more effective RFA. Facilities not able to perform EMR may be more likely to perform RFA over areas of nodularity. Early EMR appears to have a role in protecting against EAC.Table 1: Patient Characteristics by EMR performed prior to RFA

Sex and race and/or ethnicity differences in patients undergoing radiofrequency ablation for Barrett’s esophagus: results from the U.S. RFA Registry

Little is known about differences in Barrett's esophagus (BE) characteristics by sex and race and/orethnicity or these differences in response to radiofrequency ablation (RFA). We compared disease-specific characteristics, treatment efficacy, and safety outcomes by sex and raceand/or ethnicity in patients treated with RFA for BE. The U.S. RFA patient registry is a multicenter collaboration reporting processes and outcomes of care forpatients treated with RFA for BE. Patients enrolled with BE. RFA. We assessed safety (stricture, bleeding, perforation, hospitalization), efficacy(complete eradication of intestinal metaplasia [CEIM]), complete eradication of dysplasia, and number of treatments to CEIM by sex and race and/or ethnicity. Among 5521 patients (4052 men; 5126 white, 137 Hispanic, 82 African American, 40 Asian, 136 heritage not identified), women were younger (60.0 vs 62.1 years) and had shorter BE segments (3.2 vs 4.4 cm) and lessdysplasia (37% vs 57%) than did men. Women were almost twice as likely to stricture (odds ratio 1.7; 95% confidence interval, 1.2-2.3). Although white patients were predominantly male, about half of African Americans and Asians with BE were female. African Americans and Asians had less dysplasia than white patients. Asians and African Americans had more strictures than did white patients. There were no sex or race differences in efficacy. Observational study with non-mandated paradigms, no central laboratory for reinterpretation of pathology. In the U.S. RFA patient registry, women had shorter BE segments and less-aggressive histology. Theusual tendency toward BE in men was absent in African Americans and Asians. Posttreatment stricture was more common among women and Asians. RFA efficacy did not differ by sex or race.

Risk Stratification of Patients With Barrett’s Esophagus and Low-grade Dysplasia or Indefinite for Dysplasia

In patients with Barrett's esophagus (BE), low-grade dysplasia (LGD) is a risk factor for esophageal adenocarcinoma (EAC), progressing at variable rates. Patients at higher risk forprogression could benefit from intervention. We assessed rates of progression of LGD and indefinite for dysplasia (IND) and risk factors for progression to high-grade dysplasia (HGD) and EAC. We analyzed data from Cleveland Clinic Barrett's Registry on patients with BE and LGD or INDat least 1 year of follow-up from January 1, 2002 through December 31, 2012. Prevalent cases were those diagnosed at or within 1 year of the first endoscopy, and the rest were incident cases. Among 299 patients with BE and LGD or IND, there were 32 cases of HGD and 10 cases of EAC during a follow-up period of 1577.4 patient-years. The annual incidence rates were 2.4% (95% confidence interval [CI], 1.7%-3.3%) for HGD, 0.6% (95% CI, 0.3%-1.2%) for EAC, and 2.7% (95% CI, 1.9%-3.6%) for HGD or EAC. The rates were higher in men than in women with BE and LGD or IND. Prevalent cases were 3-fold more likely to progress than incident cases. Multifocality and nodules were associated with higher risk of progression to HGD or EAC. None of the patients with IND at index biopsy developed EAC. For every 5-year increase in age, chance of regression increased by 7% (P= .04). Also, for every 1-cm increase in BE length, probability of regression decreased by 6% (P= .016). LGD at index biopsy was associated with 56% lower chance of regression compared with IND (P < .001). On the basis of a database analysis of patients with BE, prevalent LGD, male sex, multifocality, and nodules were associated with higher risk for progression to EAC. Older age at LGD diagnosis, IND at index biopsy, and shorter BE length were associated with regression. These findings help in risk stratification of patients with BE and LGD or IND.

WHAT IS THE REAL IMPAIRMENT ON ESOPHAGEAL MOTILITY IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE?

Impairment of esophageal motility is a common finding in patients with gastroesophageal reflux disease (GERD) as reduced lower esophageal sphincter (LES) basal pressure. A very low LES pressure might facilitate the occurrence of more gastroesophageal reflux whereas abnormal esophageal peristalsis may contribute to impaired esophageal clearance after reflux. Evaluate the esophageal motor function of the lower esophageal sphincter and esophageal body in the various forms of gastroesophageal reflux disease. The manometrics records of 268 patients, who had evaluation of the esophageal motility as part of the diagnostic gastroesophageal reflux disease were split into four groups, as follows: 33 patients who had no esophagitis; 92 patients who had erosive esophagitis; 101 patients who had short Barrett's esophagus and 42 patients who had long Barrett's esophagus. The group who had long Barrett's esophagus showed smaller mean LES pressure and higher percentage of marked LES hypotonia; in the distal segment of the esophageal body the this group showed higher percentage of marked hypocontractility of the distal segment (<30 mm Hg); this same group showed higher percentage of esophageal motility disorders. The most intense esophageal motility disorders and lower pressure of lower esophageal sphincter were noted in the group with long Barrett's esophagus. Those with reflux esophagitis and short Barrett's esophagus had esophageal motility impairment, intermediate among patients with esophagitis and long Barrett's esophagus. Patients with typical symptoms of gastroesophageal reflux but without esophagitis by endoscopy study showed no impairment of esophageal motility.

Outcomes of Radiofrequency Ablation for Barrettʼs Esophagus

Purpose: Endoscopic ablation therapy is increasingly used in Barrett's esophagus (BE), including radio frequency ablation (RFA). The study aim was to investigate overall outcomes for our BE patients treated with RFA. Methods: Patients referred for treatment of BE underwent evaluation including endoscopic resection (EMR) and subsequent RFA therapy. We analyzed results for all patients with at least 6 months follow up data. Patients treated with other ablation methods were excluded. Demographics, endoscopic and histologic findings, complications, and outcomes were analyzed. Results: We identified 45 patients (40 men) treated for BE - no dysplasia (3), LGD (14), HGD/Ca (28) with a mean follow up of 19 months (6.6-46 mts). Mean age was 67 years (46-80 yrs), with mean max. BE segment length 5.5 cm (0.6-17 cm). 13 patients underwent prior mucosal resection. Of 127 total RFA treatments, 30 were circumferential and 97 were focal ablations (mean 2.8 RFA/patient). Overall results are summarized in the Table. 29 patients (65%) had complete resolution of intestinal metaplasia (CR-IM), 9% complete resolution of dysplasia (CR-D), 13% complete resolution of high-grade dysplasia/cancer (CR-HGD). Histology grade was unchanged in 6 patients (13%; 3 LGD, 3 HGD) with very long segments (mean 8.1 cm) after a mean 2.2 RFAs. Analysis based on initial dysplasia grade found CR-IM in all 3 patients without dysplasia (100%), 9/14 LGD patients (64%), and 17/28 HGD/Cancer patients (61%). Complications were limited to strictures in 11 patients (24%), although only 2 were severe, requiring 4 dilations each. Biopsies prior to RFAs of 17 irregular z-lines in 13 patients subsequently showed normal histology. One mild stricture was associated with these additional RFA's that resolved without dilation. Conclusion: RFA is an effective treatment for Barrett's metaplasia and dysplasia especially in shorter BE segments where CR-IM was achieved in <3 RFA treatments. Patients with high-grade dysplasia and longer BE segments required more treatments and are at risk for persistent, RFA-refractory disease that may require EMR or alternative ablation therapies. Patients with unchanged dysplasia grade had the longest BE segments suggesting the most difficult disease for RFA, however, they had the shortest follow up and fewest RFAs to date. Endoscopic assessment of irregular Z lines for complete ablation is unreliable and led to 17 additional RFA's that were performed immediately after biopsies that subsequently found no evidence of BE.Table: [1137] Overall RFA outcomes

Quality of Barrett??s surveillance in The Netherlands: a standardized review of endoscopy and pathology reports

The quality of Barrett's surveillance relies on an adequate endoscopic inspection, obtaining a sufficient number of biopsy specimens, good communication of the endoscopic findings to the pathologist, and an accurate description of the histological findings by the pathologist. The aim of this study was to assess the quality of Barrett's surveillance in daily practice in The Netherlands. A structured scoring list was developed to evaluate systematically the quality of endoscopy and pathology reports. From 15 hospitals, endoscopy reports and corresponding pathology reports were selected randomly and evaluated by two observers. In case of disagreement, the observers re-evaluated the reports in a consensus meeting. One hundred and fifty cases were evaluated. The adherence to current standard biopsy protocols (four quadrant biopsies every 2 cm) decreased with increasing Barrett's length: 0-5 cm: 79%; 5-10 cm: 50%; 10-15 cm: 30%. The indication for the endoscopy was mentioned in 28% of the pathology reports, in 4% the presence/absence of oesophagitis was communicated, and in 19% the location and/or aetiology of biopsies was described. The presence/absence of dysplasia was mentioned in 93% of pathology reports. Endoscopy reports and pathology reports in current practice do not include all relevant information for an adequate Barrett's surveillance. In short Barrett's oesophagus, the adherence to current standard biopsy protocols is acceptable, but in longer segments (with a higher risk for neoplastic progression) this is clearly insufficient. The communication between endoscopists and pathologist is suboptimal.

Endobrachyœsophage : diagnostic endoscopique et surveillance

Barrett's oesophagus (BO), or replacement of the squamous mucosa by a specialized intestinal metaplasia due to gastro-oesophageal reflux disease (GORD), predisposes to adenocarcinoma. It is estimated that 6 to 12% of patients undergoing GI endoscopy have short BO (< 3 cm), and 1% have a long BO. Macroscopic diagnosis of BO is sometimes difficult and, in case of doubt, endoscopy should be redone after a period of efficient anti-secretory treatment. Diagnosis of BO is histological and should be confirmed by biopsies. The incidence of adenocarcinoma is globally estimated at 0.5% patient by year of follow-up, and exists for both short and long BO. Due to this low incidence, screening for BO is only justified in patients at high risk for adenocarcinoma (male gender, age > 50 ans, old GORD in a young patient). Low-grade dysplasia (LGD) then high-grade dysplasia (HGD) precedes adenocarcinoma. Histological diagnosis of LGD is difficult: the main cause of confusion is inflammation so diagnosis of LGD must be confirmed after a 3-month high-dose anti-secretory treatment. Diagnosis of HGD is easier but multiple biopsies are needed to determine the focal or multifocal disposition of HGD. The benefit of follow-up of BO is debated. Aged patients should be followed only if dysplasia is present. When dysplasia is absent, an endoscopic control with biopsies is desirable within 3 to 5 years. In case of dysplasia, the latter must be confirmed by another examination of biopsies, particularly in case of suspicion of HGD and after antisecretory treatment. In case of LGD, endoscopy with biopsies should be redone 6 months later to screen for HGD, then every year if LGD is confirmed. In case of HGD, the 5-year risk of cancer is 60% so surgical or endoscopic treatment is usually proposed. If HGD follow-up is decided, it should be performed on a 3- to 6-month basis.

Improved Routine Detection of Barrett's Esophagus

The number of esophageal adenocarcinoma is growing in Europe. Despite numerous upper GI endoscopies, only few patients are diagnosed early on. As short Barrett's esophagus [BE] is now well known, this clinical condition is most probably diagnosed during routine endoscopic examinations. The aim of this study is to test a fixed magnification endoscope and its endoscopic possibilities for cardia examinations. Method: From February to October 2003, 153 examinations were performed with a prototype Olympus XGIF Q160 E, which has the usual technical features of a commercially available gastroscope plus a modifying lens that enables fixed magnification [magnification ×60], allowing for easier minute examination of digestive mucosa. Chromoscopy was carried out with 3 % acetic acid and the endoscopic diagnosis was confirmed by target biopsies. A plastic cap was used in order to maintain a close focus. Patients: 138 patients were referred for reflux symptoms; 15 patients were Barrett's esophagus follow-up patients. The use of a fixed magnification endoscope allowed for careful examination of the cardia area with: oesophageal squamous mucosa, Z-line, cardial mucosa with regular pattern spread from 2-5 mm, and then fundus mucosa. In 15 Barrett's esophagus patients: distorted pattern, hypervascularisation area, or enlarged grooves were seen. Compared to a usual magnification endoscope [magnification ×80 to 120], it was not possible to determine detailed patterns such as complete intestinal metaplasia or dysplasia. In 138 patients with reflux, we were able to diagnose Barrett's esophagus in 8 cases [3 short, 5 ultra-short]. The handling of a fixed magnification endoscope, with or without plastic cap, is less cumbersome than the usual magnification endoscope [Olympus GIF Q160 Z]. Conclusion: Short Barrett's esophagus is probably under diagnosis during routine endoscopy. Fixed magnification endoscope with acetic acid and chromoscopy increases the endoscopic yield. Examination of the cardia with magnification and chromoscopy should be performed routinely.

Barrett's Dysplasia and Mucosal Carcinoma Patients Referred for Photodynamic Therapy --- Do They Come from Surveillance Programs?

Introduction: The utility and cost effectiveness of surveillance endoscopy for patients with Barrett's esophagus (BE) has been questioned. Since 1997, we have used photodynamic therapy (PDT) to treat patients with Barrett's high-grade dysplasia and mucosal adenocarcinoma. The aim of this study was to determine if these patients were newly diagnosed or were referred from endoscopic surveillance programs. Methods: We reviewed our experience treating patients with PDT for Barrett's high-grade dysplasia and mucosal adenocarcinoma in order to determine their symptoms at presentation and how many of these patients were newly diagnosed or if they had been detected by surveillance endoscopy. Wilcoxon rank sum tests and Fisher's exact tests were used to compare patient characteristics and outcomes according to endoscopy surveillance status. Results: Since 1997, 90 patients have undergone endoscopic ablation with PDT including sixty patients with Barrett's high-grade dysplasia and 30 mucosal adenocarcinoma patients. Of these 90 patients, 71 were men and the median age was 72 years (age range 50-85 years) with a median series follow up of 1.6 years. Most patients were referred for PDT from endoscopy surveillance programs (49 patients, 54%) where patients had been followed with a diagnosis of BE for a median 5 years. Most of these patients (39 patients; 80%) had symptoms of chronic acid reflux disease. Other symptoms leading to diagnosis were chest pain, bleeding and dysphagia. Forty-one newly diagnosed patients, without previously diagnosed BE, were referred for PDT (46%). Symptoms leading to their endoscopy and diagnosis were bleeding (14 patients; 34%), chest pain (11 patients; 27%), dysphagia (8 patients; 20%) and chronic acid reflux (6 patients; 15%). The only statistically significant difference between these two groups of patients was the Barrett segment length (5 cm for surveillance patients vs. 3 cm for newly diagnosed patients, p<0.001). Conclusions: In this highly selected group, most patients with Barrett's high-grade dysplasia or mucosal adenocarcinoma are referred from endoscopic surveillance programs (54%) and were diagnosed based on their symptoms of chronic acid reflux. Patients newly diagnosed with Barrett's high-grade dysplasia or mucosal adenocarcinomas make up a sizable proportion of our study group (46%). Their lack of typical acid reflux symptoms and significantly shorter BE segments may explain the delay in their diagnosis.

Diagnosis of esophagogastric tumors.

Esophagogastric tumors occur in three sectors: the esophagus, the EG junction and the non-cardia stomach. Neoplasia develops in the squamous stratified epithelium of the esophagus and in the columnar epithelium of the Barrett's esophagus or in the stomach. At the junction, tumors arise either in a very short Barrett's esophagus or in the gastric epithelium of the cardia. The prognosis of tumors detected at the advanced stage is poor. Secondary prevention requires detection at the early stage. Most superficial neoplastic lesions in the esophagus and in the stomach have a non-protruding appearance, which is similar for premalignant and malignant lesions. Improved accuracy in endoscopic diagnosis and prediction of histology prior to biopsy and treatment decision is based upon magnification with a optical zoom and electronic processing of the captured image with structure enhancement, enhancement of the color of hemoglobin and narrow band imaging. This applies particularly to the exploration of the Barrett's esophagus for identification of the areas with intestinal metaplasia and of flat neoplastic areas. In spite of the predictive value of endoscopy for histology, biopsy samples are still required for pathology and eventually studies with biological markers. Spectroscopic techniques provide a new perspective, up to the level of molecular endoscopy, but they are unlikely to be cost/effective. The classification in the sub-types 0 of neoplastic lesions has some relevance to prediction of depth of invasion. In the esophagus, EUS staging with high frequency miniprobes is a useful complement.

Small adenocarcinomas of the esophagogastric junction: association with intestinal metaplasia and dysplasia.

Intestinal metaplasia in Barrett's esophagus predisposes to esophageal adenocarcinoma. Intestinal metaplasia of the cardia is a common finding in persons without cancer. Many adenocarcinomas of the esophagogastric junction are large enough to obliterate any underlying intestinal metaplasia. To estimate how often adenocarcinoma of the esophagogastric junction arises in intestinal metaplasia, we studied small adenocarcinomas of the esophagogastric junction. Resection patients had adenocarcinomas 2 cm or smaller, within 2 cm of the esophagogastric junction. Age- and sex-matched controls had resection for squamous carcinoma. Saved and new histological slides from the esophagogastric junction were examined, with additional stains. Intestinal metaplasia was found in 86% (19/22) of adenocarcinoma cases, versus 32% (7/22) of controls (p < 0.001). Intestinal metaplasia with high or low grade dysplasia was associated with 64% (14/22) of adenocarcinomas and with 5% (1/22) of controls (p < 0.001). Excluding four cases with long and three with short Barrett's esophagus, 80% (12/15) of adenocarcinomas had associated intestinal metaplasia, 53% (8/15) with dysplasia. Most adenocarcinoma cases had the incomplete type of intestinal metaplasia with a Barrett type cytokeratin 7/20 staining pattern. Helicobacter pylori were seen in one adenocarcinoma and five control cases. Most adenocarcinomas of the esophagogastic junction arise in the background of intestinal metaplasia, sometimes in an endoscopically visible Barrett's esophagus, more often in small areas of intestinal metaplasia of the cardia. In cases of adenocarcinoma, the intestinal metaplasia resembled that found in Barrett's esophagus, and was not associated with H. pylori.

Long and short Barrett's esophagus: Clinic and histological features

Long and short Barrett's esophagus: Clinic and histological features