Seminars in Thoracic and Cardiovascular Surgery
Volume 17, Issue 4 , Pages 292-300, Winter 2005

Barrett’s Esophagus: Pathologic Considerations and Implications for Treatment

  • Thomas W. Rice, MD

      Affiliations

    • Cleveland Clinic Lerner College of Medicine, Section of General Thoracic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio.
    • Corresponding Author InformationAddress reprint requests to Thomas W. Rice, MD, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F24, Cleveland OH 44195.
    • ,
  • Joel E. Mendelin, MD

      Affiliations

    • Gastrointestinal Pathology, Department of Anatomic Pathology, The Cleveland Clinic Foundation, Cleveland, Ohio.
    • ,
  • John R. Goldblum, MD

      Affiliations

    • Cleveland Clinic Lerner College of Medicine, Department of Anatomic Pathology, The Cleveland Clinic Foundation, Cleveland, Ohio.

Barrett’s esophagus (BE) is a complication of chronic reflux that results in the replacement of esophageal squamous epithelium with columnar epithelium. BE is endoscopically recognized and pathologically confirmed. The presence of goblet cells is diagnostic. The pathologist must also determine if dysplasia or invasive cancer is present. Acceptable terms for dysplasia are no dysplasia, indefinite for dysplasia, low-grade dysplasia (LGD), or high-grade dysplasia (HGD). It can be difficult to differentiate HGD from intramucosal cancer (IMC) in an endoscopic biopsy specimen. Treatment based on this differentiation is problematic. Indications for treatment of BE are similar to those of patients without BE. Treatment will not cause clinically significant regression of BE or prevent progression to cancer. Cancer development following successful antireflux surgery is uncommon.

Keywords:  Barrett’s esophagus , high-grade dysplasia , intramucosal cancer , Barrett’s adenocarcinoma

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PII: S1043-0679(05)00081-X

doi:10.1053/j.semtcvs.2005.10.002

Seminars in Thoracic and Cardiovascular Surgery
Volume 17, Issue 4 , Pages 292-300, Winter 2005

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