Barrett's esophagus: pathologic considerations and implications for treatment.
Barrett's esophagus (BE) is a complication of chronic reflux that results in the replacement of esophageal squamous epithelium with columnar epithelium. BE is endoscopically recognized and pathologically confirmed. The presence of goblet cells is diagnostic. The pathologist must also determine if dysplasia or invasive cancer is present. Acceptable terms for dysplasia are no dysplasia, indefinite for dysplasia, low-grade dysplasia (LGD), or high-grade dysplasia (HGD). It can be difficult to differentiate HGD from intramucosal cancer (IMC) in an endoscopic biopsy specimen. Treatment based on this differentiation is problematic. Indications for treatment of BE are similar to those of patients without BE. Treatment will not cause clinically significant regression of BE or prevent progression to cancer. Cancer development following successful antireflux surgery is uncommon.
Rice
Thomas W
TW
Cleveland Clinic Lerner College of Medicine, Section of General Thoracic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. ricet@ccf.org
Mendelin
Joel E
JE
Goldblum
John R
JR
D000230:Adenocarcinoma / Q000473:pathology; D001471:Barrett Esophagus / Q000473:pathology* / Q000628:therapy; D018450:Disease Progression; D004848:Epithelium / Q000473:pathology; D004938:Esophageal Neoplasms / Q000473:pathology; D020397:Goblet Cells / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D007422:Intestines / Q000473:pathology; D008679:Metaplasia; D009092:Mucous Membrane / Q000473:pathology