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“Short” Barrett's esophagus: A condition not to be underestimated

1994; Elsevier BV; Volume: 40; Issue: 1 Linguagem: Inglês

10.1016/s0016-5107(94)70030-3

1097-6779

Mássimo Conio, H. Aste, L Bonelli,

Gastric Cancer Management and Outcomes

Barrett's esophagus (BE) is considered to be a complication of long-lasting gastroesophageal reflux and represents the pre-neoplastic condition for esophageal adenocarcinoma.1Hameeteman W Tytgat GNJ Houthof HJ Van der Tweel JG Barrett's esophagus: development of dysplasia and adenocarcinoma.Gastroenterology. 1989; 96: 1249-1256Abstract Full Text PDF PubMed Scopus (871) Google Scholar Histologically, the neoplastic risk seems to be confined to the specialized columnar epithelium (SCE), which appears to be a variant of incomplete intestinal metaplasia.2Reid BJ Weinstein WM Lewin KJ Haggitt RC Van Deventer G DenBesten L Rubin CE Endoscopic biopsy can detect high- grade dysplasia, early adenocarcinoma in Barrett's esophagus without grossly recognizable neoplastic lesions.Gastroenterology. 1988; 94: 81-90PubMed Google Scholar Until now, the development of dysplasia and of adenocarcinoma has been reported in SCE only, and it correlates with the length of metaplastic epithelium.3Iftikhar SY James PD Steele RJC Hardcastle JD Atkinson M Length of Barrett's esophagus: an important factor in the development of dysplasia and adenocarcinoma.Gut. 1992; 33: 1155-1158Crossref PubMed Scopus (261) Google Scholar However, Schnell et al.4Schnell TG Sontag SJ Chejfec G Adenocarcinomas arising in tongues or short segments of Barrett's esophagus.Dig Dis Sci. 1992; 37: 137-143Crossref PubMed Scopus (248) Google Scholar pointed out that dysplasia as well as adenocarcinoma may arise also in small areas of SCE. Moreover, no clear endoscopic guidelines exist with regard to the diagnosis of BE because different minimal lengths of metaplastic epithelium have been suggested.5Winters Jr, C Spurling TJ Chobanian SJ et al.Barrett's esophagus: a prevalent occult complication of gastroesophageal reflux disease.Gastroenterology. 1987; 92: 118-124PubMed Google Scholar, 6Rothery GA Patterson JE Stoddard CJ Day DW Histological and histochemical changes in the columnar lined (Barrett's) esophagus.Gut. 1986; 27: 1062-1068Crossref PubMed Scopus (73) Google Scholar In the Gruppo Operativo per lo Studio delle Precancerosi dell'Esofago (G.O.S.P.E.) study, we enrolled 166 patients showing, at endoscopy, short extensions (0.5 to 2 cm) of metaplastic epithelium ( Fig. 1 ). These patients underwent biopsies from the lower third of the esophagus because of associated esophagitis in most cases. Histologic results showed SCE in 32 patients (19.3%); 27 of them (84.4%) had gastroesophageal reflux symptoms. Low-grade dysplasia was detected in three cases (9.4%); in these cases the extension of BE was less than 1 cm. The percentage of dysplasia observed in this sub-group of patients overlaps that observed in the whole cohort of patients with SCE, irrespective of the length of BE. This observation suggests that small areas resembling metaplastic epithelium should be routinely biopsied and that a substantial percentage of cases of SCE will be detected. In addition, even if this is a preliminary observation, the frequency of dysplasia in short segments of BE was similar to that previously reported (9.1%) by our group in a subset of the G.O.S.P.E. cohort study involving only subjects with BE longer than 3 cm.7G.O.S.P.E Barrett's esophagus: epidemiological and clinical results of a multicentric survey.Int J Cancer. 1991; 48: 364-368Crossref PubMed Scopus (111) Google Scholar All patients in whom the histologic diagnosis of SCE is obtained should undergo a periodic endoscopic follow-up irrespective of the length of metaplastic epithelium.