Barrett’s esophagus

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barrets esophagus

Salud y medicina

Mucosal Pathology of Gastric
Cardia and Barrett’s oesophagus

Gastro-esophageal junction

Endoscopic Biopsy Surveillance

Normal esophagus

Normal gastric cardia

Gastric fundus

Oesophageal biopsy origin
• Oesophageal submucosal glands
or ducts,
• Native squamous epithelium
• Multilayered epithelium

Goblet cell mimickers

Alcian blue stain,at pH2.5

Grading dysplasia in Barrett’s
esophagus algorithm
• Surface maturation compared to
underlying glands
• Architecture of the glands
• Cytologic features
• Inflammation and erosions/ulcers

Barretts Esophagus, No dysplasia

Indefinite

Barretts Esophagus,low grade

Low grade,tubular adenoma

High grade

Intramucosal carcinoma

Invasive carcinoma

Narrow band imaging

Autofluorescence

Cofocal laser endomicroscopy

BIOMARKERS FOR RISK
STRATIFICATION
• PLOIDY
• TP53
• Aberrant tumour suppressor gene promoter
methylation

Follow up of Barrett’s esophagus
Dysplasia grade Documentation Followup
None Two EGDs with
biopsy
3yr
Low grade Highest grade on
repeat
1yr until no
dysplasia
High grade Repeat endoscopy
to exclude cancer
,expert confirmation
Every 3 month

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Barrett’s esophagus

1. Mucosal Pathology of Gastric Cardia and Barrett’s oesophagus

2.

3. Gastro-esophageal junction

4. Endoscopic Biopsy Surveillance

5. Normal esophagus

6. Normal gastric cardia

7. Gastric fundus

8. Oesophageal biopsy origin • Oesophageal submucosal glands or ducts, • Native squamous epithelium • Multilayered epithelium

9. Goblet cell mimickers

10. Alcian blue stain,at pH2.5

11. Grading dysplasia in Barrett’s esophagus algorithm • Surface maturation compared to underlying glands • Architecture of the glands • Cytologic features • Inflammation and erosions/ulcers

12. Barretts Esophagus, No dysplasia

14. Barretts Esophagus,low grade

15. Low grade,tubular adenoma

17. Intramucosal carcinoma

18. Invasive carcinoma

19. Narrow band imaging

20. Autofluorescence

21. Cofocal laser endomicroscopy

22. BIOMARKERS FOR RISK STRATIFICATION • PLOIDY • TP53 • Aberrant tumour suppressor gene promoter methylation

23. Follow up of Barrett’s esophagus Dysplasia grade Documentation Followup None Two EGDs with biopsy 3yr Low grade Highest grade on repeat 1yr until no dysplasia High grade Repeat endoscopy to exclude cancer ,expert confirmation Every 3 month