Primary Motility  Disorders of the  Esophagus
 The Esophageal
 Mucosa
 The
 Esophagogastric  Junction
 Barrett's
 Esophagus

  Browse by Author
  Browse by Movies
OESO©2015
 
Volume: Barrett's Esophagus
Chapter: Dysplasia
 

How frequently can high-grade dysplasia be found in normal subjects?

A.P. Weston (Kansas City)

The frequency of detecting high-grade dysplasia (HGD) at initial (index) diagnosis of Barrett's esophagus (i.e. prevalence of HGD within Barrett's) is about 2%, ranging from

Table I. Prevalence of Barrett's high grade dysplasia subgrouped according to length.

1.0% to 2.8% depending upon whether Barrett's is short segment (< 3 cm) or long segment (> 3 cm) (Table I).

Concerning the issue of "normal" appearing mucosa, our center has prospectively evaluated the endoscopic mucosal appearance of HGD in a 29 de novo, non-dysplastic referral Barrett's esophagus patients [13]. Overall, in 23/29 (79%) patients the Barrett's mucosa harboring HGD was entirely normal. In 6/29 (21%) patients the HGD was noted to be found within a visible mucosal lesion (a DALM lesion) whose appearance consisted of - a Barrett's ulcer - 2 pts, a Barrett's nodule - 1 pt, and a friable/nodular erythematous focus - 3 pts. Hence, in a non-referral biased group of Barrett's esophagus patients, HGD remains predominantly a histologic diagnosis not accompanied by endoscopic findings to target biopsy. In contrast, the appearance of Barrett's HGD in those referred to a tertiary center specializing in Barrett's due to presence of abnormal biopsy/dysplasia the mucosal appearance pattern of HGD is different [14]: normal - 14/29 (48.3%), DALM lesions (51.7%) including: stricture (with nodularity with or without friability) - 2, ulcer (with nodularity, plaque, or polypoid) - 11, nodularity alone - 1, focus of friability alone - 1.

References

1. Hameetemann W, Tytgat GN, Houthoff HJ, et al. Barrett's esophagus:development of dysplasia and adenocarcinoma. Gastroenterology 1989;96:1249-1256.

2. G.O.S.P.E. Barrett's esophagus: epidemiologic and clinical results of a multicentric study. Int J Cancer 1991;48:364-368.

3. Miros M, Kerlin P, Walker N. Only patients with dysplasia progress to adenocarcinoma in Barrett's oesophagus. Gut 1991;32(12):1441-1446.

4. Bonelli L, G.O.S.P.E. Barrett's esophagus: results of a multicentric survey. Endoscopy 1993;25(Suppl.) 652-654.

5. Weston AP, Krmpotich PT, Cherian R, et al. Prospective long-term endoscopic and histologic follow-up of short segment Barrett's esophagus: comparison to traditional long segment Barrett's esophagus. Am J Gastroenterol 1997;92:407-413.

6. Sharma P, Morales T, Bhattacharya A, et al. Dysplasia in short-segment Barrett's esophagus: a prospective 3-year follow up. Am J Gastroenterol 1997;92(11):2012-2016.

7. O'Connor BJ, Falk GW, Richter JE. The incidence of adenocarcinoma and dysplasia in Barrett's esophagus. Am J Gastroenterol 199;94:2037-2042.

8. Conio M, Filberti R, Blanchi S, et al. Long-term endoscopic surveillance of patients with Barrett's esophagus. A prospective study. Gastroenterology 2000;118:A223.

9. Zaman MS, Robson K, Rosenberg S, et al. The development of dysplasia on follow-up endoscopy among patients with short segment Barrett's esophagus: a cohort of 61 patients followed for a mean of 30 months. Gastrointest Endosc 2000;51:AB115.

10. Feldshon DS. Rodlund JL. Barrett's esophagus. Surveillance for short and long segment disease. Gastrointest Endosc 2000;51:AB117.

11. Hillman LC, Chiragakis L, Kaye GL, et al. Significance of short segment Barrett's esophagus. Gastroenterology 2000;118:A222.

12. Sharma P, Weston AP, Morales T, et al. Relative risk of dysplasia for patients with intestinal metaplasia in the distal oesophagus. Gut 2000;46(1):9-13.

13. Weston AP, Sharma P, Banerjee SK, et al. Endoscopic appearance of Barrett's hig-grade dysplasia at index diagnosis. Am J Gastroenterol 2000 (submitted/accepted).

14. Levine DS, Haggitt RC, Blount PL, et al. An endoscopic biopsy protocol can differentiate high-grade dysplasia from early adenocarcinoma in Barrett's esophagus. Gastroenterology 1993;105:4-50.


Publication date: August 2003 OESO©2015