Barrett's Esophagus

Question 1

Appearance of Barrett’s endoscopically

Answer 1

Salmon colored appeance of mucosa

Question 2

What percentage of patients with Barrett’s esophagus with high grade dysplasia will progress to cancer?

Answer 2

10-30%

Question 3

What are the recommended guidelines for biopsies in Barrett’s esophagus?

Answer 3

Four quadrant biopsies at 2cm intervals from 1cm below EG junction to 1cm above the squamocolumnar junction.

Question 4

What is the interval between endoscopic surveillance in Barrett’s if no dysplastic changes are seen on biopsy?

Answer 4

2 to 3 years

Question 5

What if low grade dysplasia is found on endoscopic evaluation of Barretts?

Answer 5

Recommend endoscopic surveillance at 6 month intervals for first year, then yearly if no progression

Question 6

If a patient presents with Barrett’s and high grade dysplasia on biopsy, what is recommended before a definitive diagnosis can be made?

Answer 6

Diagnosis of high grade dysplasia must be confirmed by a second, independent, experienced pathologist.

Question 7

What is the prevalence of low grade dysplasia in Barrett’s?

Answer 7

15-25%

Question 8

What is the prevalence of high grade dysplasia in Barrett’s?

Answer 8

5%

Question 9

If a patient presents with high grade dysplasia, what are his treatment options?

Answer 9

Continued surveillance until carcinoma is identified, mucosal ablative techniques, and esophagectomy.

Question 10

A patient with BE with high grade dysplasia undergoes an esophagectomy. What is the likelihood of finding invasive carcinoma in the specimen?

Answer 10

40%!!!!!

Question 11

What is the recommended treatment for high grade Barrett’s?

Answer 11

Esophagectomy

Question 12

How can early adenocarcinoma within the Barrett’s mucosa be removed?

Answer 12

With EMR (endoscopic mucosal resection)

Question 13

How is Barrett’s medically treated?

Answer 13

Lifetime proton pump inhibitors

Question 14

What role does antireflux surgery have in Barrett’s esophagus?

Answer 14

Minimizing reflux symptoms (evidence that controlling symptoms isimportant to protect against dysplastic changes and promote regression)

Question 15

True or False: If a patient with a history of Barrett’s esophagus (w/ no dysplasia) undergoes antireflux surgery, they require no further follow-up and the risk of cancer is eliminated.

Answer 15

False. They still require endoscopic surveillance because antireflux surgery has not been shown to clearly alter disease progression from metaplasia to carcinoma.