Original articleClinical endoscopyLow prevalence of submucosal invasive carcinoma at esophagectomy for high-grade dysplasia or intramucosal adenocarcinoma in Barrett's esophagus: a 20-year experience
Section snippets
Definitions
BE is defined as columnar metaplasia, with goblet cells, identified in biopsy specimens obtained from the esophagus above the gastroesophageal junction.19 HGD in BE shows increased crypt complexity, crowding, irregularity, and branching, with more pronounced nuclear stratification, loss of nuclear polarity, pleomorphism, and mitotic activity.20 IMC is defined as neoplastic epithelium that has invaded beyond the basement membrane into the surrounding lamina propria or muscularis mucosae but not
Results
Sixty patients in total were included in the study, 41 with preoperative HGD and 19 with preoperative IMC. Table 1 summarizes the demographic features. The response rate of the administered survey was 83%. The mean age at diagnosis of HGD or IMC was 61 ± 10 years. Fifty-five (92%) patients were men, and 97% were white. Table 2 summarizes the pathologic findings in the esophagectomy specimens stratified by pre-esophagectomy diagnosis. At esophagectomy, 4 of 60 patients (6.7%; 95% CI, 1.8%-16.2%)
Discussion
This study describes one of the largest series of patients undergoing esophagectomy for BE with HGD or IMC. The low rate (6.7%) of submucosal invasion at esophagectomy in patients with BE with HGD or IMC on biopsy sharply contrasts with the frequently quoted 40% risk of occult cancer. Submucosal invasion is an important end point in studies of such patients because HGD and IMC can potentially be treated by local therapies such as PDT, RFA, or EMR. Importantly, submucosal invasion confers a risk
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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. This study was funded by the Ken and Louise Goldberg Award.
Presented in part at Digestive Disease Week, May 17-22, 2008, San Diego, California (Gastroenterology 2008;134:M1598).
See CME section; p. 914.