Esophageal Intestinal Metaplasia (Barrett's Esophagus) Accompanies Most Esophageal and Gastroesophageal Junction Adenocarcinomas – A Single Institution Experience
Gautam V Shah, Elizabeth A Montgomery. Johns Hopkins Medical Institutions, Baltimore, MD
Background: The American College of Gastroenterologists and the American Gastroenterological Association both currently require the presence of intestinal metaplasia to diagnose Barrett's esophagus and thereby enroll patients for follow-up screening for adenocarcinoma. Some observers believe that this requirement should be widened to include all columnar epithelium identified in the esophagus.
Design: We searched pathology archives of our institution for patients diagnosed with adenocarcinoma of the esophagus or gastroesophageal junction whose primary biopsies and resections and follow-up were at our institution between May 2002 and April 2012. We assessed for specimens obtained both prior to and after their adenocarcinoma diagnosis to learn if these patients had any samples in our institution's archives showing intestinal metaplasia in the esophagus (Barrett's esophagus).
Results: There were 241 patients diagnosed with adenocarcinoma said to be in the esophagus. In 21 patients (9%), there was no documentation of background esophageal intestinal metaplasia whereas the remaining 220 (91%) were shown to have intestinal metaplasia. Most of the esophageal adenocarcinomas unassociated with intestinal metaplasia were poorly differentiated (14/21, 67%). There were an additional 77 patients diagnosed with adenocarcinoma said to involve the “gastroesophageal junction”. In 14 (18%), no esophageal intestinal metaplasia was identified, whereas esophageal intestinal metaplasia was identified in the remaining 63 (82%). Most of the tumors unassociated with intestinal metaplasia of the gastroesophageal junction were poorly differentiated (9/14; 64%). Overall, esophageal intestinal metaplasia was detected in 89% of persons diagnosed with esophageal or gastroesophageal junction adenocarcinoma.
Conclusions: These results support the current requirement for esophageal intestinal metaplasia as an entry point into adenocarcinoma surveillance protocols, both for esophageal adecocarcinomas and "gastroesophageal junction" adenocarcinoma; some of the latter are presumably gastric lesions, with slightly different risk factors.
Monday, March 4, 2013 11:45 AM
Proffered Papers: Section D, Monday Morning