Clinical significance and management of Barrett’s esophagus with epithelial changes indefinite for dysplasia

Abstract

Barrett's esophagus (BE) is defined as the extension of salmon-colored mucosa into the tubular esophagus ≥ 1 cm proximal to the gastroesophageal junction with biopsy confirmation of intestinal metaplasia. Patients with BE are at increased risk of esophageal adenocarcinoma (EAC), and undergo endoscopic surveillance biopsies to detect dysplasia or early EAC. Dysplasia in BE is classified as no dysplasia, indefinite for dysplasia (IND), low grade dysplasia (LGD) or high grade dysplasia (HGD). Biopsies are diagnosed as IND when the epithelial abnor malities are not sufficient to diagnose dysplasia or the nature of the epithelial abnormalities is uncertain due to inflammation or technical issues. Specific diagnostic criteria for IND are not well established and its clinical significance and management has not been well studied. Previous studies have focused on HGD in BE and led to changes and improvement in the management of BE with HGD and early EAC. Core tip: Barrett's esophagus (BE) with indefinite for dysplasia (IND) is diagnosed when the epithelial abnor malities are not sufficient to diagnose dysplasia or the nature of the epithelial abnormalities is uncertain due to inflammation. The risk of prevalent neoplasia in BE with IND varies between 1.9% and 15%. The progression to advanced neoplasia reported varies from 0.43 to 1.2 cases per 100 personyears at risk. Predictors such as the length of BE segment, multifocality of BE IND, age > 60

Non‐conventional dysplasias of the tubular gut: a review and illustration of their histomorphological spectrum

“…They should also assess whether there is continuity of atypia with the surface to establish a diagnosis of traditional dysplasia. Despite the unequivocal evidence of neoplasia reported in two articles, 13,14 some authors have adopted a more cautious alternative attitude of reporting ‘indefinite for dysplasia’ when BGD is observed in isolation 18–20 . This approach may reflect the uncertainty in differentiating BGD from metaplastic reactive atypia.…”

The risk of neoplasia in patients with Barrett's esophagus indefinite for dysplasia: a multicenter cohort study

“…BE-IND could also be diagnosed when there were technical factors precluding a reliable assessment of the epithelium, such as biopsy crushing artifact, thermal artifact, and tangential embedding and sectioning. 18 An example of a case of BE-IND is presented in Figure 1.…”

Laparoscopic Antireflux Surgery: Are Old Questions Answered? Should It Be Used Conjoined With Endoscopic Therapy for Barrett’s Esophagus?

“…In BE IND, either the epithelial abnormalities are insufficient for a diagnosis of dysplasia, or the nature of the epithelial abnormalities is uncertain due to inflammation or technical difficulties with specimen processing. The risk of HGD or cancer within 1 year of the diagnosis of IND varies between 1.9% and 15% 55 . The recommendation from ACG 47 for management is to optimize acid suppressive therapy for 3-6 months and then to repeat esophagogastroduodenoscopy (EGD).…”