Barrett's oesophagus diagnostic criteria: endoscopy and histology

Naini, Bita V.; Chak, Amitabh; Ali, Meer; Odze, Robert D.

doi:10.1016/j.bpg.2014.11.004

Cited by 21 publications

(11 citation statements)

References 98 publications

(103 reference statements)

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“…There are inherent problems with the endoscopic and pathologic criteria used to define CLE 5-7 . For instance, endoscopically, it is difficult to identify very short or ultrashort segments of CLE, particularly in patients with a hiatus hernia 5 .…”

Section: Introductionmentioning

confidence: 99%

“…This condition is quite common in the general population 8,10 . Thus, it is often difficult for endoscopists and pathologists to be certain whether columnar mucosa within biopsies obtained from an irregular Z-line represents metaplastic columnar mucosa of the distal esophagus or normal mucosa of the gastric cardia 6,7 . Biopsies from this region occasionally demonstrate histologic features indicative of esophageal columnar metaplasia, such as multilayered epithelium (ME), submucosal glands or ducts in patients who do not have endoscopic evidence of CLE, but the significance of these findings are also unclear 6,13 .…”

Section: Introductionmentioning

confidence: 99%

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Histologic Features Associated With Columnar-lined Esophagus in Distal Esophageal and Gastroesophageal Junction (GEJ) Biopsies From GERD Patients

Soucy

Onstad

Vaughan

et al. 2016

American Journal of Surgical Pathology

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Background There are inherent problems with the endoscopic and pathologic criteria for columnar-lined esophagus (CLE). Furthermore, the clinical and biological significance of an irregular squamocolumnar junction (SCJ) is unclear. The aim of this study was to evaluate the association between histologic features in SCJ biopsies and CLE, and to gain insight into the significance of an irregular SCJ. Design The study was a cross-sectional analysis of 2176 mucosal biopsies of the SCJ from 544 patients in a large prospective community clinic-based study of GERD in Washington State. Biopsy samples were evaluated blindly for a wide variety of histologic features, such as the presence and type of mucosal glands, submucosal glands and ducts, goblet cells, multilayered epithelium (ME), inflammation, and buried columnar epithelium. Histologic findings were correlated with the endoscopic findings [normal Z-line, irregular Z-line or CLE], and evaluated by logistic regression and ROC analysis. Results Five histologic features were associated with CLE: pure mucous glands, ME, presence of goblet cells, ≥50% of crypts with goblet cells, and buried columnar epithelium. Pure oxyntic glands was inversely associated with CLE. The features most strongly related to CLE included biopsies with ≥50% of crypts with goblet cells, ME, and mucosal gland type (AUC=0.71; 95%CI=0.66-0.76). Patients with an irregular Z-line were histologically similar to those with CLE. Conclusions Certain histologic features in biopsies of the SCJ are associated with the presence of CLE. Irregularity of the Z-line is probably indicative of ultrashort segment CLE, instead of being a potential variation of normal.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Histologic Features Associated With Columnar-lined Esophagus in Distal Esophageal and Gastroesophageal Junction (GEJ) Biopsies From GERD Patients

Soucy

Onstad

Vaughan

et al. 2016

American Journal of Surgical Pathology

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“…From a pathological point of view, the histological criteria to diagnose BE are variable on a worldwide scale (11). In fact, in Europe and the United States the diagnosis of BE requires the presence (or absence) in esophageal biopsies from endoscopically identified areas of columnar mucosa of intestinal metaplasia, characterized by goblet cells (12)(13)(14)(15), whereas the British Society of Gastroenterology requires histological documentation of metaplastic columnar mucosa, but not the presence of goblet cells (16), and in Japan no histological confirmation of endoscopically documented esophageal columnar lined mucosa is required (17).…”

Section: Introductionmentioning

confidence: 99%

The importance of a second opinion in the diagnosis of Barretts esophagus: a real life study

et al. 2016

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“…They should describe the presence or absence of intestinal metaplasia. If intestinal metaplasia is present, this feature can be further qualified with a comment mentioning "IM seen in the biopsy may be representative of BE if biopsies are derived from the tubular esophagus in the setting of appropriate endoscopic features" (29). This is because the intestinal metaplasia of the GEJ or gastric cardia is not associated with increased risk of cancer.…”

Section: Issues In Diagnosis Of Bementioning

confidence: 99%

“…These landmarks include the distal end of long palisading esophageal vessels and the proximal ends of gastric folds (29). These can be obscured in the presence of hiatal hernia or severe reflux esophagitis.…”

Section: Issues In Diagnosis Of Bementioning

confidence: 99%

Pathology of esophageal cancer and Barrett’s esophagus

Jain

Dhingra

2017

Ann. Cardiothorac. Surg.

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Esophageal cancer is a serious malignancy with high mortality. The two common distinctive pathologic subtypes of esophageal cancer are squamous cell carcinoma and adenocarcinoma. These differ with regards to etiology, ethnic distribution, pathogenesis, and location in the esophagus. The precursor lesions are also unique to each subtype. Squamous cell carcinoma is more common in East Asia, is linked to smoking and tobacco use, more commonly involves the middle esophagus, and the precursor lesion is squamous dysplasia.Adenocarcinoma is more common in the United States and certain European countries, associated with obesity and gastroesophageal reflux disease (GERD), more commonly involves the distal esophagus, and the precursor lesion is Barrett's esophagus. Endoscopic surveillance with biopsy evaluation is the standard of care in high-risk groups. Endoscopic ablative therapies for early cancers have lower morbidity than surgery. Despite increased awareness, identification of high-risk groups and endoscopic surveillance, a large proportion of patients present with advanced cancers. Surgery and chemoradiation, either in neo-adjuvant or adjuvant setting, is the usual treatment for patients with advanced but resectable esophageal cancers. The prognosis and further management largely depends upon the pathologic tumor-node-metastasis (TNM) staging provided by the American Joint Committee on Cancer (AJCC) and the International Union against Cancer. Currently, the 7th edition of TNM staging system is being applied for prognostication and this is more focused on pathologic evaluation. Eighth edition of AJCC/UICC TNM staging has been introduced and will be implemented for clinical use in 2018.

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Barrett's oesophagus diagnostic criteria: endoscopy and histology

Cited by 21 publications

References 98 publications

Histologic Features Associated With Columnar-lined Esophagus in Distal Esophageal and Gastroesophageal Junction (GEJ) Biopsies From GERD Patients

Histologic Features Associated With Columnar-lined Esophagus in Distal Esophageal and Gastroesophageal Junction (GEJ) Biopsies From GERD Patients

The importance of a second opinion in the diagnosis of Barretts esophagus: a real life study

Pathology of esophageal cancer and Barrett’s esophagus

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Barrett's oesophagus diagnostic criteria: endoscopy and histology

Cited by 21 publications

References 98 publications

Histologic Features Associated With Columnar-lined Esophagus in Distal Esophageal and Gastroesophageal Junction (GEJ) Biopsies From GERD Patients

Histologic Features Associated With Columnar-lined Esophagus in Distal Esophageal and Gastroesophageal Junction (GEJ) Biopsies From GERD Patients

The importance of a second opinion in the diagnosis of Barretts esophagus: a real life study

Pathology of esophageal cancer and Barrett’s esophagus

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The importance of a second opinion in the diagnosis of Barretts esophagus: a real life study