title: Endoscopic mucosal resection of Barrett's esophagus detects high prevalence of subsquamous intestinal metaplasia.
abstract: OBJECTIVE
  To report the prevalence of Subsquamous intestinal metaplasia (SSIM) in patients undergoing endoscopic mucosal resection (EMR) for staging of Barrett's esophagus (BE).
  
  
  METHODS
  Thirty-three patients with BE associated neoplasia underwent EMR at our institution between September 2009 and September 2011; 22 of these patients met study inclusion criteria. EMR was targeted at focal abnormalities within the BE segment. EMR was performed in standardized fashion using a cap-assisted band ligation technique, and resection specimens were assessed for the presence of SSIM. Demographic and clinical data were analyzed to determine predictors of SSIM.
  
  
  RESULTS
  SSIM was detected in 59% of patients. SSIM was detected in 73% of patients with short segment (< 3 cm) BE, and in 45% of patients with long-segment (≥ 3 cm) BE (P = NS). There was no association between presence/absence of SSIM and age, gender, or stage of BE-associated neoplasia.
  
  
  CONCLUSIONS
  EMR detects SSIM in a majority of patients with BE-associated neoplasia. While the long-term clinical significance of SSIM remains uncertain, these results highlight the importance of EMR as an optimal diagnostic tool for staging of BE and detection of SSIM, and should further limit concerns that SSIM is purely a post-ablation phenomenon.
authors.affiliation: Patrick Yachimski, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN 37232-5280, United States.
authors.forename: Patrick
authors.initials: P
authors.lastname: Yachimski
authors.affiliation: Patrick Yachimski, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN 37232-5280, United States.
authors.forename: Chanjuan
authors.initials: C
authors.lastname: Shi
authors.affiliation: Patrick Yachimski, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN 37232-5280, United States.
authors.forename: James C
authors.initials: JC
authors.lastname: Slaughter
authors.affiliation: Patrick Yachimski, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN 37232-5280, United States.
authors.forename: Mary Kay
authors.initials: MK
authors.lastname: Washington
keywords: Barrett epithelium; Barrett esophagus; Endoscopy; Esophageal cancer; Pathology