Download - Barrett’s esophagus
Mucosal Pathology of Gastric Cardia and Barrett’s oesophagus
Gastro-esophageal junction
Endoscopic Biopsy Surveillance
Normal esophagus
Normal gastric cardia
Gastric fundus
Oesophageal biopsy origin
• Oesophageal submucosal glands or ducts,
• Native squamous epithelium
• Multilayered epithelium
Goblet cell mimickers
Alcian blue stain,at pH2.5
Grading dysplasia in Barrett’s esophagus algorithm
• Surface maturation compared to underlying glands
• Architecture of the glands
• Cytologic features
• Inflammation and erosions/ulcers
Barretts Esophagus, No dysplasia
Indefinite
Barretts Esophagus,low grade
Low grade,tubular adenoma
High grade
Intramucosal carcinoma
Invasive carcinoma
Narrow band imaging
Autofluorescence
Cofocal laser endomicroscopy
BIOMARKERS FOR RISK STRATIFICATION
• PLOIDY
• TP53
• Aberrant tumour suppressor gene promoter methylation
Follow up of Barrett’s esophagus
Dysplasia grade Documentation Followup
None Two EGDs with biopsy
3yr
Low grade Highest grade on repeat
1yr until no dysplasia
High grade Repeat endoscopy to exclude cancer ,expert confirmation
Every 3 month