title: Detection and staging of esophageal cancers within Barrett's esophagus is improved by assessment in specialized Barrett's units.
abstract: BACKGROUND
  Identification and resection of mucosal abnormalities are critical in managing dysplastic Barrett's esophagus (BE) because these areas may harbor esophageal adenocarcinoma (EAC).
  
  
  OBJECTIVE
  To compare mucosal lesion and EAC detection rates in dysplastic BE in the community versus a BE unit and assess the impact of EMR on disease staging and management.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Patients with dysplastic BE.
  
  
  METHODS
  Reassessment with high-definition white-light endoscopy (HD-WLE), narrow-band imaging (NBI), and Seattle protocol biopsies. EMR performed in lesions thought to harbor neoplasia. Review of referral histology and endoscopies.
  
  
  METHODS
  Mucosal lesion and EAC detection rates in a BE unit versus the community. Impact of EMR on management.
  
  
  RESULTS
  Sixty-nine patients were referred (88% male; median age, 69 years). At referral, HD-WLE/NBI use was 57%/14%, and Seattle protocol adherence was 20%. Eighteen patients had intramucosal cancer. Lesions were detected in 65 patients in the BE unit versus 29 patients at referral (P < .001). EMR was performed in 47 patients. BE unit assessment confirmed EAC in all 18 patients and identified 10 additional patients (56% increased cancer detection, P = .036); all 10 had lesions identified in the BE unit (vs 3 identified at referral). EMR in these patients found submucosal cancer (n = 4) and intramucosal cancer (n = 6), resulting in esophagectomy (n = 4) and chemoradiotherapy (n = 1).
  
  
  CONCLUSIONS
  Academic center.
  
  
  CONCLUSIONS
  BE assessment at a BE unit resulted in increased lesion and EAC detection. EMR of early cancers was critical in optimizing patient management. These data suggest that BE unit referral be considered in patients with dysplastic BE.
authors.affiliation: St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Georgina R
authors.initials: GR
authors.lastname: Cameron
authors.affiliation: St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Chatura S
authors.initials: CS
authors.lastname: Jayasekera
authors.affiliation: St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Williams
authors.affiliation: Royal Melbourne Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Finlay A
authors.initials: FA
authors.lastname: Macrae
authors.affiliation: St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Paul V
authors.initials: PV
authors.lastname: Desmond
authors.affiliation: St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Taylor
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D059248:Chemoradiotherapy; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D016629:Esophagectomy; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology* / Q000601:surgery; D005260:Female; D005762:Gastroenterology / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology* / Q000601:surgery; D062048:Narrow Band Imaging; D009367:Neoplasm Staging; D011446:Prospective Studies; D011787:Quality of Health Care; D012017:Referral and Consultation; D013038:Specialization