title: Location, location, location: does early cancer in Barrett's esophagus have a preference?
abstract: BACKGROUND
  Early cancer (high-grade dysplasia [HGD] and intramucosal carcinoma [ImCa]) associated with Barrett's esophagus (BE) may have a circumferential spatial predilection.
  
  
  OBJECTIVE
  To describe the esophageal circumferential location of early cancer in BE.
  
  
  METHODS
  Retrospective study, single tertiary referral center.
  
  
  METHODS
  One hundred nineteen patients were referred for endoscopic eradication therapy for early cancer associated with BE. Endoscopic images and reports and pathology were reviewed.
  
  
  METHODS
  Circumferential location designation of early cancer in BE by using a clock-face orientation.
  
  
  RESULTS
  One hundred nineteen of 131 patients referred for endoscopic eradication therapy had a location designation for their advanced histology (91.9%). There were a total of 57 patients (47.9%) with HGD and 62 patients (52.1%) with ImCa. There was a significantly higher rate of early cancer (HGD or ImCa) in the right hemisphere (12 to 6 o'clock location) compared with the left hemisphere (84.9% vs 15.1%, P < .0001). The highest percentage of early cancer was found in the 12 to 3 o'clock quadrant (64.7%); 71.9% of HGD and 58.1% of ImCa lesions were located in the 12 to 3 o'clock quadrant.
  
  
  CONCLUSIONS
  Retrospective design, single center.
  
  
  CONCLUSIONS
  Early cancer associated with BE is far more commonly found in the right hemisphere of the esophagus (12 to 6 o'clock) with the highest rate in the 12 to 3 o'clock quadrant. These findings support enhanced scrutiny of the right hemisphere of the esophagus during surveillance and endoscopic treatment of patients with BE.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Brintha K
authors.initials: BK
authors.lastname: Enestvedt
authors.forename: Ricardo
authors.initials: R
authors.lastname: Lugo
authors.forename: Carlos
authors.initials: C
authors.lastname: Guarner-Argente
authors.forename: Pari
authors.initials: P
authors.lastname: Shah
authors.forename: Gary W
authors.initials: GW
authors.lastname: Falk
authors.forename: Emma
authors.initials: E
authors.lastname: Furth
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Ginsberg
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology*; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology / Q000601:surgery; D009361:Neoplasm Invasiveness; D011230:Precancerous Conditions / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies
keywords: BE; Barrett’s esophagus; HGD; ImCa; high-grade dysplasia; intramucosal carcinoma