GASTROENTEROLOGY ARTICLE OF THE WEEK
October 17, 2002
Sampliner R. Updated guidelines for the diagnosis, surveillance and therapy of Barrett’s esophagus. Am J Gastroenterol 2002;97:1888-1895.
1. Diagnosis of Barrett’s esophagus
a. requires biopsy for histologic examination
b. Alcian-blue staining may increase the diagnostic yield
c. Highest yield is in African American males with long-standing reflux symptoms
d. Barrett’s in the absence of GERD symptoms is distinctly unusual.
2. Surveillance endoscopy in Barrett’s
a. should be done every year indefinitely
b. can be performed every 3 years after 2 consecutive endoscopies show no
dysplasia
c. is not needed as often in short-segment Barrett’s
d. should only be performed if there is a potential to prolong life in a given
individual.
3. Focal high grade dysplasia is defined as
a. high grade dysplasia in only of the biopsy samples
b. high grade dysplasia affecting less than 5 crypts
c. high grade dysplasia over a focal lesion (nodule) on the esophagus
d. high grade dysplasia that can only be found when attendings do the biopsy
True or False
4. Low grade dysplasia invariably progresses to cancer in most individuals
5. Diffuse high-grade dysplasia has a higher risk of progression to cancer compared to focal high-grade dysplasia.
6. Patients with Barrett’s esophagus should be treated with high dose proton pump inhibitors with pH monitoring to allow for no detectable acid reflux, regardless of the presence or absence of symptoms.
7. Dysplasia associated with a nodule is no different than dysplasia on flat mucosa.
8. Once high grade dysplasia develops on flat mucosa, progression to malignancy is very likely
9. A patient has low grade dysplasia on endoscopy, appropriate follow up should be
a. repeat the endoscopy in 3 years
b. repeat the endoscopy in 3 months
c. repeat the endoscopy in 1 year
d. repeat the endoscopy in 51 days
e. refer for esophagectomy
10. A patient has focal high grade dysplasia after undergoing extensive biopsies of the esophagus using large-capacity biopsy forceps. Proper follow would include
a. repeat the endoscopy in 3 years
b. repeat the endoscopy in 3 months
c. repeat the endoscopy in 1 year
d. repeat the endoscopy in 51 days
e. refer for esophagectomy