Length of Barrett’s esophagus in the presence of low-grade dysplasia, high-grade dysplasia, and adenocarcinoma

Barrie, J.R.; Yanni, Fady; Sherif, Mohamed; Dube, A; Tamhankar, Anand P.

doi:10.1007/s00464-020-07950-5

Cited by 10 publications

(7 citation statements)

References 34 publications

(44 reference statements)

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“…In cases where multiple biopsies from different sites were available, the biopsy from the most distal aspect of BE segment was selected for analysis. This selection was based on data that suggests that a substantial proportion of dysplasia and EAC occurs in the distal oesophagus, close to the gastro-oesophageal junction 13 14. In 41/75 cases, we examined a single NDBE biopsy, in 28/75 cases we evaluated two serial NDBE biopsies and in 6/75 cases we examined 3 serial NDBE biopsies obtained at different time intervals (figure 1).…”

Section: Methodsmentioning

confidence: 99%

Quantitative p53 immunostaining aids in the detection of prevalent dysplasia

et al. 2023

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AimsThe lack of accepted scoring criteria has precluded the use of p53 in routine practice. We evaluate the utility of automated quantitative p53 analysis in risk stratifying Barrett’s oesophagus (BE) patients using non-dysplastic BE (NDBE) biopsies in a multicentric cohort of BE progressor (P) and non-progressor (NP) patients.MethodsNDBE biopsies prior to the diagnosis of advanced neoplasia from 75 BE-P, and index and last surveillance biopsies from 148 BE-NP were stained for p53, and scored digitally as 1+, 2+ and 3+. A secondary cohort of 30 BE-P was evaluated.ResultsCompared with BE-NP, BE-P was predominantly men (p=0.001), ≥55 years of age (p=0.008), with longer BE segments (71% vs 33%; p<0.001). The mean number of 3+p53 positive cells and 3+ positive glands were significantly more in BE-P versus BE-NP NDBE biopsies (175 vs 9.7, p<0.001; 9.8 vs 0.1; p<0.001, respectively). At a cut-off of ≥10 p53 (3+) positive cells, the sensitivity and specificity of the assay to identify BE-P were 39% and 93%. On multivariate analysis, scoring p53 in NDBE biopsies, age, gender and length of BE were significantly associated with neoplastic progression. 54% of patients classified as prevalent dysplasia showed an abnormal p53 immunohistochemical stain. These findings were validated in the secondary cohort.ConclusionsAutomated p53 analysis in NDBE biopsies serves as a promising tool for assessing BE neoplastic progression and risk stratification. Our study highlights the practical applicability of p53 assay to routine surveillance practice and its ability to detect prevalent dysplasia.

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Section: Methodsmentioning

confidence: 99%

Quantitative p53 immunostaining aids in the detection of prevalent dysplasia

et al. 2023

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“…recently reported that almost 20% of all dysplasia in BE and EAC occurs within a centimeter of the EGJ, suggesting that all lengths of CLE above the EGJ should be recognized as BE and subjected to a thorough biopsy protocol. 50 …”

Section: Diagnosis Of Bementioning

confidence: 99%

“…48 Although most studies show that the incidence of EAC in BE of less than 1 cm in length is very low, 49 Barrie et al recently reported that almost 20% of all dysplasia in BE and EAC occurs within a centimeter of the EGJ, suggesting that all lengths of CLE above the EGJ should be recognized as BE and subjected to a thorough biopsy protocol. 50 Traditionally, BE is divided into long-segment BE (LSBE, ≥3 cm) and SSBE (<3 cm) based on the length of columnar mucosa in the distal esophagus as assessed by endoscopy. Although not clearly defined in all guidelines, BE less than 1 cm in length is termed ultrashort-segment BE (USSBE).…”

Section: What Is the Optimal Landmark For The Egj?mentioning

confidence: 99%

“…Although most studies show that the incidence of EAC in BE of less than 1 cm in length is very low, 49 Barrie et al. recently reported that almost 20% of all dysplasia in BE and EAC occurs within a centimeter of the EGJ, suggesting that all lengths of CLE above the EGJ should be recognized as BE and subjected to a thorough biopsy protocol 50 …”

Section: Diagnosis Of Bementioning

confidence: 99%

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Endoscopic diagnosis and screening of Barrett's esophagus: Inconsistency of diagnostic criteria between Japan and Western countries

et al. 2021

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Barrett's esophagus (BE) is an endoscopically identifiable premalignant condition for esophageal adenocarcinoma (EAC). To diagnose BE precisely, careful inspection of the anatomic landmarks, including the esophagogastric junction and the squamocolumnar junction is important. The distal end of the palisade vessels and the proximal end of the gastric folds are used as the landmark of the esophagogastric junction in endoscopic diagnosis, with the latter solely used internationally, except in some Asian countries, including Japan. In addition, the diagnostic criteria adopted internationally for BE are inconsistent, particularly between Japan and Western countries. Recently updated guidelines in Western countries have included length criteria, with a 1‐cm threshold of columnar epithelium by endoscopic observation and/or histologic confirmation of the presence of specialized intestinal metaplasia. Since BE is endoscopically diagnosed at any length without histologic assessment in Japan, the reported prevalence of short‐segment BE is very high in Japan compared with that in Western countries. Although guidelines on screening exist for BE, the current strategies based on the presence of chronic gastroesophageal reflux disease with multiple risk factors may miss the opportunity for early detection of EAC. Indeed, up to 40% of patients with EAC have no history of chronic gastroesophageal reflux disease. To discuss BE on the same footing worldwide, standardization of diagnostic criteria, screening indication, and establishment of effective techniques for detecting dysplastic lesions are eagerly awaited. Japanese guidelines for BE should be revised regarding the length criteria, including the minimum length and long‐segment BE, in line with the recently updated Western guidelines.

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“…By extension, it may be difficult to accurately report on the presence or absence of irregular Z-line, which is 1 cm or less in extent. The concern around irregular Z line comes from studies that have shown that as much as 20% of all dysplasia occurs in BE <1 cm and 20% of EAC occur within one cm of gastroesophageal junction [23]. These authors recommended that all lengths of columnar lined epithelium above the gastroesophageal junction be recognized as Barrett's metaplasia and be surveyed.…”

Section: Irregular Z Line and Risk Of Progressionmentioning

confidence: 99%

How extent of Barrett's metaplasia influences the risk of esophageal adenocarcinoma

Meyer

Hejazi

Bansal

2021

Current Opinion in Gastroenterology

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Purpose of reviewThis review will focus on how the extent of Barrett's metaplasia influences the risk of esophageal adenocarcinoma (EAC). More specifically, this review will discuss the concepts of long and short-segment Barrett's metaplasia and irregular Z line as they relate to EAC risk.Recent findingsThe Prague classification can standardize reporting of Barrett's metaplasia. Recent literature has found significant associations between the length of Barrett's metaplasia and increased progression risk to EAC in multiple geographically distinct populations. Length of Barrett's metaplasia has been incorporated into the Progression of Barrett's esophagus (PIB) model that can predict individualized life-time risks of progression. The risk of malignant transformation appears to be very low in patients with irregular Z line.SummaryLength of Barrett's metaplasia has emerged as an important predictor that can influence the risk of EAC and should be reported using the Prague classification. The PIB model, if further validated, could help a practicing gastroenterologist to inform patients with Barrett's metaplasia about their personal risk of progression to tailor surveillance intervals. Current guidelines do not recommend surveillance in patients with irregular Z line, but careful examination is recommended.

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Length of Barrett’s esophagus in the presence of low-grade dysplasia, high-grade dysplasia, and adenocarcinoma

Cited by 10 publications

References 34 publications

Quantitative p53 immunostaining aids in the detection of prevalent dysplasia

Quantitative p53 immunostaining aids in the detection of prevalent dysplasia

Endoscopic diagnosis and screening of Barrett's esophagus: Inconsistency of diagnostic criteria between Japan and Western countries

How extent of Barrett's metaplasia influences the risk of esophageal adenocarcinoma

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