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Gastrointest Endosc. 2012 May;75(5):938-44. doi: 10.1016/j.gie.2011.12.025. Epub 2012 Mar 3.

Circumferential location predicts the risk of high-grade dysplasia and early adenocarcinoma in short-segment Barrett's esophagus.

Author information

1
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.

Abstract

BACKGROUND:

Whether early Barrett's neoplasia has a predilection for particular spatial locations in shorter segment disease is currently unknown. Anatomic factors may play a role in lesion location because of differing levels of mucosal acid exposure.

OBJECTIVE:

To identify high-risk lesion locations, which has important implications for surveillance strategies.

DESIGN:

We interrogated a prospectively maintained database of patients who underwent endoscopic resection (ER) for Barrett's neoplasia at 2 Australian tertiary centers. Lesions targeted for ER were characterized and their location in the distal esophagus was noted as on a clock face. A Z test of proportions was used to test for deviation from uniformity in the distribution of lesions.

SETTING:

Two Australian tertiary centers.

PATIENTS:

Patients who underwent ER for Barrett's neoplasia.

MAIN OUTCOME MEASUREMENTS:

Lesion location in the distal oesophagus, resected specimen histology.

RESULTS:

A total of 146 consecutive patients had ER for biopsy-proven high-grade dysplasia or esophageal adenocarcinoma. A total of 75 patients had Barrett's segment length of 5 cm or less and a visible lesion. Five patients had 2 visible lesions giving a total of 80 lesions. ER of 66 lesions (82.5%) led to the identification of advanced pathology: 37 high-grade dysplasia (46%), 24 mucosal adenocarcinoma (30%), 5 submucosal adenocarcinoma (6%). Of a total of 80 lesions, 43 (53.8%) (95% CI, 42.9%-64.7%) were centered within the 2- to 5-o'clock arc, comprising 25% of the circumference. This area also accounted for 36 (54.5%) of the 66 lesions with advanced histology (95% CI, 42.5%-66.5%). All confidence intervals lie wholly above the 25% expected in a uniform circular distribution (P < .05).

LIMITATIONS:

Observational study in a tertiary center.

CONCLUSIONS:

In Barrett's maximal segments of 5 cm or less, the 2- to 5-o'clock arc, accounts for approximately 50% of macroscopically visible lesions and associated early neoplasia. This finding has important implications for surveillance strategies.

PMID:
22381529
DOI:
10.1016/j.gie.2011.12.025
[Indexed for MEDLINE]

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