Surgical Endoscopy

, Volume 27, Issue 8, pp 2836–2840

Expert pathology review and endoscopic mucosal resection alters the diagnosis of patients referred to undergo therapy for Barrett’s esophagus

  • Katie Ayers
  • Chanjuan Shi
  • Kay Washington
  • Patrick Yachimski
Article

DOI: 10.1007/s00464-013-2830-x

Cite this article as:
Ayers, K., Shi, C., Washington, K. et al. Surg Endosc (2013) 27: 2836. doi:10.1007/s00464-013-2830-x

Abstract

Background

Endoscopic therapy has emerged as an alternative to surgical esophagectomy for the management of Barrett’s esophagus (BE)-associated neoplasia. Accurate pretreatment staging is essential to ensure an appropriate choice of therapy and optimal long-term outcomes. This study aimed to assess the frequency with which expert histopathologic review of biopsies combined with endoscopic mucosal resection (EMR) would alter the pretreatment diagnosis of BE-associated neoplasia.

Methods

Patients referred to the Vanderbilt Barrett’s Esophagus Endoscopic Treatment Program (V-BEET) were retrospectively identified. Demographic, histopathologic, and endoscopic data were extracted from the medical record.

Results

For this study, 29 subjects referred for endoscopic staging of BE fulfilled the entry criteria. The referral diagnosis was low-grade dysplasia (LGD) in 3 % (1/29), high-grade dysplasia (HGD) in 62 % (18/29), intramucosal adenocarcinoma (T1a) adenocarcinoma in 17 % (5/29), and invasive adenocarcinoma in 17 % (5/29) of the subjects. Expert histopathologic review of available referral biopsy specimens altered the diagnosis in 33 % (5/15) of the cases. Further diagnostic staging with EMR showed BE without dysplasia in 10 % (3/29), LGD in 14 % (4/29), HGD in 34 % (10/29), T1a adenocarcinoma in 28 % (8/29), and invasive adenocarcinoma in 14 % (4/29) of the patients. The combination of expert histopathologic review and EMR altered the initial diagnosis for 55 % (16/29) of the subjects, with 56 % (9/16) upstaged to more advanced disease and 44 % (7/16) downstaged to less advanced disease.

Conclusions

The practice of combined expert histopathologic review and EMR alters the pretreatment diagnosis for the majority of patients with BE-associated neoplasia. Caution is advised for those embarking on endoscopic or surgical treatment for BE-associated neoplasia in the absence of these staging methods.

Keywords

Barrett’s esophagus BE-associated neoplasia Endoscopic mucosal resection Histopathologic review Pretreatment staging 

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Katie Ayers
    • 1
  • Chanjuan Shi
    • 2
  • Kay Washington
    • 2
  • Patrick Yachimski
    • 1
  1. 1.Division of Gastroenterology, Hepatology, and NutritionVanderbilt University Medical CenterNashvilleUSA
  2. 2.Department of Pathology Microbiology, and ImmunologyVanderbilt University Medical CenterNashvilleUSA

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