Barrett's Esophagus

Question 1

Define and treatment

Answer 1

Definition
x Barrett’s esophagus (BE) is defined as the presence of intestinal metaplasia of ≥ 1cm that replaces the normal
stratified squamous epithelium.
ƒ This change is recognized endoscopically by its salmon-colored mucosa and histologically by
Showing intestinal metaplasia and goblet cells.
*Irregular Z-line or segments less than 1 cm should be referred to as specialized intestinal
metaplasia of the GE junction, and are not associated with increased risk of malignancy

Question 2

Screening

Answer 2

Endoscopic screening for BE is recommended in the following groups of patients:
* Male patients with >5 years symptoms of GERD (heartburn or acid regurgitation)
+
two or more of the following
risk factors:
1- first degree relative with BE or esophageal adenocarcinoma (most important risk factor).
2- age >50 years
3-Caucasian race.
4-central obesity,.
5-current or past history of smoking.
* Screening is not recommended in women with chronic reflux (ACG), but it could be considered if multiple risk

Question 3

Management

Answer 3

1-No dysplasia..
Screen every 3-5 years
No need for ablation
2- Indefinite for dysplasia
*Optimize PPI therapy
*Repeat EGD in 3-6 months.
3-Low grade dysplasi
*Confirm with another endoscopy and biopsy within 3-6 month.
Surveillance EGD every 1 year until no dysplasia on 2 exams
or
x Endoscopic ablation
x EMR if nodular dysplasia
4-High grade dysplasia
Confirm with another endoscopy and biopsy within 3-6 month.
*EMR if nodular dysplasia
*Endoscopic ablation
5-Intramucosal esophageal
adenocarcinoma (T1a)
(Tumor invades lamina propria or muscularis mucosa )
x EMR and ablation preferred over esophagectomy
6-Submucosal esophageal
adenocarcinoma (T1b)
Tumor invades submucosa x EMR and ablation is an alternative to
esophagectomy if low risk features†
especially if poor surgical candidate