Columnar Epithelium-Lined (Barrett’s) Esophagus: Mucosal Neoplasias

  • Pierre H. DeprezEmail author
  • Takashi Toyonaga


Columnar-lined Barrett’s esophagus (BE) requires endoscopic surveillance for risk of adenocarcinoma. A course of proton pump inhibitor pretreatment reduces inflammatory changes and facilitates endoscopic recognition and histologic diagnosis of dysplasia. Detection of HGIN or early cancer (T1 m) demands close inspection for any irregularities, which must then be analyzed on magnifying endoscopy. The degree of invasiveness of early cancer is predictable from macroscopic type, alteration of microvascular architecture on magnifying narrow-band imaging (NBI), and irregularity of surface structure on acetic acid chromoendoscopy. Endoscopic resection with curative intention by EMR or ESD can be offered for HGIN or noninvasive or microinvasive mucosal carcinoma, when free margins (R0) are achieved on well-differentiated or moderately differentiated superficial adenocarcinoma (category T1 m or T1b-sm1) without lymphovascular invasion. However, cancer with deeper submucosal invasion (T1b-sm2-3), lymphovascular invasion, or poor differentiation (G3) should undergo surgical esophagectomy for cure.


Barrett´s esophagus, classification Columnar epithelium-lined esophagus Adenocarcinoma Diagnosis of dysplasia Surface structure Microvessel pattern Endoscopic en-bloc resection Resective surgery, indications 



We gratefully acknowledge the contribution of ESD cases by Dr. Tsuneo Oyama, Nagano, Japan; Dr. Hans P. Allgaier, Freiburg and Dr. Micheal Anzinger, Munich, Germany; and Dr. Frieder Berr and Dr. Daniel Neureiter, Salzburg, Austria.


  1. 1.
    van Blankenstein M, et al. The incidence of adenocarcinoma and squamous cell carcinoma of the esophagus: Barrett’s esophagus makes a difference. Am J Gastroenterol. 2005;100:766–74.CrossRefGoogle Scholar
  2. 2.
    Spechler SJ, et al. American Gastroenterological Association medical position statement on the management of Barrett’s esophagus. Gastroenterology. 2011;140:1084–91.CrossRefGoogle Scholar
  3. 3.
    Kelty CJ, et al. Barrett’s oesophagus: intestinal metaplasia is not essential for cancer risk. Scand J Gastroenterol. 2007;42:1271–4.CrossRefGoogle Scholar
  4. 4.
    Kuwano H, et al. Guidelines for diagnosis and treatment of carcinoma of the esophagus April 2012 edited by the Japan Esophageal Society. Esophagus. 2015;12:1–30.CrossRefGoogle Scholar
  5. 5.
    Kastelein F, et al. Impact of surveillance for Barrett’s oesophagus on tumor stage and survival of patients with neoplastic progression. Gut. 2016;65:548–54.CrossRefGoogle Scholar
  6. 6.
    Shaheen NJ, et al. ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol. 2016;111:30–50.CrossRefGoogle Scholar
  7. 7.
    Sharma P, et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology. 2006;131:1392–9.CrossRefGoogle Scholar
  8. 8.
    Weusten B, et al. Endoscopic management of Barrett’s esophagus: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy. 2017;49:191–8.CrossRefGoogle Scholar
  9. 9.
    Lambert R. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc. 2003;58:S3–43.CrossRefGoogle Scholar
  10. 10.
    Paris Workshop on columnar metaplasia in the esophagus and the esophagogastric junction, Paris, France, December 11–12 2004. Endoscopy. 2005;37:879–920.Google Scholar
  11. 11.
    Oyama T. Diagnostic strategies of superficial Barrett’s esophageal cancer for endoscopic submucosal dissection. Dig Endosc. 2013;25(Suppl 1):7–12.CrossRefGoogle Scholar
  12. 12.
    Pech O, et al. Prospective evaluation of the macroscopic types and location of early Barrett’s neoplasia in 380 lesions. Endoscopy. 2007;39:588–93.CrossRefGoogle Scholar
  13. 13.
    Theisen J, et al. Preferred location for the development of esophageal adenocarcinoma within a segment of intestinal metaplasia. Surg Endosc. 2006;20:235–8.CrossRefGoogle Scholar
  14. 14.
    Kandiah K, et al. International development and validation of a classification system for the identification of Barrett’s neoplasia using acetic acid chromoendoscopy: the Portsmouth acetic acid classification (PREDICT). Gut 2018;67:2085–91.Google Scholar
  15. 15.
    Muto M, et al. Magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA-G). Dig Endosc. 2016;28:379–93.CrossRefGoogle Scholar
  16. 16.
    Sharma P, et al. Development and validation of a classification system to identify high-grade dysplasia and esophageal adenocarcinoma in Barrett’s esophagus using narrow-band imaging. Gastroenterology. 2016;150:591–8.CrossRefGoogle Scholar
  17. 17.
    Sharma P, et al. Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett’s oesophagus: a prospective, international, randomised controlled trial. Gut. 2013;62:15–21.CrossRefGoogle Scholar
  18. 18.
    Singh M, et al. Observer agreement in the assessment of narrowband imaging system surface patterns in Barrett’s esophagus: a multicenter study. Endoscopy. 2011;43:745–51.CrossRefGoogle Scholar
  19. 19.
    Kato M, et al. Image assessment of Barrett’s esophagus using the simplified narrow band imaging classification. J Gastroenterol. 2017;52:466–75.CrossRefGoogle Scholar
  20. 20.
    Zemler B, et al. Early Barrett’s carcinoma: the depth of infiltration of the tumour correlates with the degree of differentiation, the incidence of lymphatic vessel and venous invasion. Virchows Arch. 2010;456:609–14.CrossRefGoogle Scholar
  21. 21.
    Pech O, et al. The impact of endoscopic ultrasound and computed tomography on the TNM staging of early cancer in Barrett’s esophagus. Am J Gastroenterol. 2006;101:2223–9.CrossRefGoogle Scholar
  22. 22.
    Anagnostopoulos GK, et al. Novel endoscopic observation in Barrett’s oesophagus using high resolution magnification endoscopy and narrow band imaging. Aliment Pharmacol Ther. 2007;26:501–7.CrossRefGoogle Scholar
  23. 23.
    Goda K, et al. Usefulness of magnifying endoscopy with narrow band imaging for the detection of specialized intestinal metaplasia in columnar-lined esophagus and Barrett’s adenocarcinoma. Gastrointest Endosc. 2007;65:36–46.CrossRefGoogle Scholar
  24. 24.
    Goda K, et al. Current status of endoscopic diagnosis and treatment of superficial Barrett’s adenocarcinoma in Asia-Pacific region. Dig Endosc. 2013;25(Suppl 2):146–50.CrossRefGoogle Scholar
  25. 25.
    Oyama T. Diagnosis of gastric adenocarcinoma with magnified endoscopy. In: Oyama T, editor. Endoscopic diagnosis of superficial gastric cancer for ESD. Tokyo, Japan: Springer; 2016. p. 39–51.Google Scholar
  26. 26.
    Yamagata T, et al. Efficacy of acetic acid-spraying method in diagnosing extension of Barrett’s cancer under the squamous epithelium. Dig Endosc. 2012;24:309–14.CrossRefGoogle Scholar
  27. 27.
    Pimentel-Nunes P, et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2015;47:829–54.CrossRefGoogle Scholar
  28. 28.
    Pech O, et al. Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus. Gastroenterology. 2014;146:652–660.e651.CrossRefGoogle Scholar
  29. 29.
    Manner H, et al. Early Barrett’s carcinoma with “low-risk” submucosal invasion: long-term results of endoscopic resection with a curative intent. Am J Gastroenterol. 2008;103:2589–97.CrossRefGoogle Scholar
  30. 30.
    Phoa KN, et al. Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II). Gut. 2016;65:555–62.CrossRefGoogle Scholar
  31. 31.
    Dunbar KB, et al. The risk of lymph-node metastases in patients with high-grade dysplasia or intramucosal carcinoma in Barrett’s esophagus: a systematic review. Am J Gastroenterol. 2012;107:850–62; quiz 863.CrossRefGoogle Scholar
  32. 32.
    Leers JM, et al. The prevalence of lymph node metastases in patients with T1 esophageal adenocarcinoma a retrospective review of esophagectomy specimens. Ann Surg. 2011;253:271–8.CrossRefGoogle Scholar
  33. 33.
    Kawaguchi G, et al. The effectiveness of endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer. Radiat Oncol. 2015;10:31.CrossRefGoogle Scholar
  34. 34.
    Takeuchi M, et al. Technical feasibility and oncological safety of diagnostic endoscopic resection for superficial esophageal cancer. Gastrointest Endosc. 2018;88:456–65.CrossRefGoogle Scholar
  35. 35.
    Kara MA, et al. Detection and classification of the mucosal and vascular patterns (mucosal morphology) in Barrett’s esophagus by using narrow band imaging. Gastrointest Endosc. 2006;64:155–66.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing 2019

Authors and Affiliations

  1. 1.Department of Hepato-GastroenterologieCliniques Universitaires Saint-Luc, Université Catholique de LouvainBrusselsBelgium
  2. 2.Department of EndoscopyKobe University HospitalKobeJapan

Personalised recommendations