Primary Motility  Disorders of the  Esophagus
 The Esophageal
 Esophagogastric  Junction

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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.


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Publication date: August 2003 OESO©2015