title: Directional distribution of neoplasia in Barrett's esophagus is not influenced by distance from the gastroesophageal junction.
abstract: BACKGROUND
  Accurate endoscopic detection and staging are critical for appropriate management of Barrett's esophagus (BE)-associated neoplasia. Prior investigation has demonstrated that the distribution of endoscopically detectable early neoplasia is not uniform but instead favors specific directional distributions within a short BE segment; however, it is unknown whether the directional distribution of neoplasia differs with increasing distance from the gastroesophageal junction, including in patients with long-segment BE.
  
  
  OBJECTIVE
  To identify whether directional distribution of BE-associated neoplasia is influenced by distance from the gastroesophageal junction.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary-care referral center.
  
  
  METHODS
  Patients with either short-segment or long-segment BE undergoing EMR.
  
  
  METHODS
  EMR.
  
  
  METHODS
  Directional distribution of BE-associated neoplasia stratified by distance from gastroesophageal junction.
  
  
  RESULTS
  EMR was performed on 60 lesions meeting study criteria during the specified time period. Pathology demonstrated low-grade dysplasia in 22% (13/60), high-grade dysplasia in 38% (23/60), intramucosal (T1a) adenocarcinoma in 23% (14/60), and invasive (≥ T1b) adenocarcinoma in 17% (10/60). Directional distribution of lesions was not uniform (P < .001), with 62% of lesions (37/60) located between the 1 o'clock and 5 o'clock positions. When circular statistics methodology was used, there was no difference in the directional distribution of neoplastic lesions located within 3 cm of the gastroesophageal junction compared with ≥ 3 cm from the gastroesophageal junction.
  
  
  CONCLUSIONS
  Single-center study may limit external validity.
  
  
  CONCLUSIONS
  The directional distribution of neoplastic foci within a BE segment is not influenced by distance of the lesion from the gastroesophageal junction. Mucosa between the 1 o'clock and 5 o'clock locations merits careful attention and endoscopic inspection in individuals with both short-segment BE and long-segment BE.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee 37232-5280, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Cassani
authors.forename: Eric
authors.initials: E
authors.lastname: Sumner
authors.forename: James C
authors.initials: JC
authors.lastname: Slaughter
authors.forename: Patrick
authors.initials: P
authors.lastname: Yachimski
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D001471:Barrett Esophagus / Q000150:complications / Q000473:pathology* / Q000601:surgery; D002278:Carcinoma in Situ / Q000150:complications / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D004943:Esophagogastric Junction / Q000473:pathology*; D004945:Esophagoscopy; D006801:Humans; D009092:Mucous Membrane / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies