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Intestinal Metaplasia is Present in Most if Not All Patients Who Have Undergone Endoscopic Mucosal Resection for Esophageal Adenocarcinoma. | LitMetric

AI Article Synopsis

  • Barrett esophagus is currently defined by the presence of intestinal metaplasia in the esophagus, which is believed to indicate a higher risk for developing adenocarcinoma.
  • Recent discussions suggest that nonintestinalized cardiac epithelium should also be considered part of Barrett esophagus, as seen in definitions used in England and Japan.
  • A study of 27 endoscopic mucosal resections found that the absence of intestinal metaplasia in some specimens is likely due to sampling errors, and thorough reviews showed that intestinal metaplasia is often present in patients with adenocarcinoma, supporting its role as a necessary precursor to this type of cancer.

Article Abstract

Barrett esophagus is presently defined in the United States by the presence of intestinal metaplasia in columnar-lined esophagus based on the premise that the risk for adenocarcinoma depends on the presence of intestinal metaplasia. Recently, arguments have been made that nonintestinalized cardiac epithelium is also at risk and should be included in the definition of Barrett esophagus, as it is in England and Japan. One of these arguments is that residual intestinal metaplasia is frequently absent around early adenocarcinomas removed by endoscopic mucosal resection (EMR). We reviewed 27 EMRs performed in 21 patients. Residual intestinal metaplasia was absent in 10/27 (37%) EMR specimens. An in-depth study of these 10 cases showed that 3 had intestinal metaplasia in a concurrent second EMR specimen, 4 had intestinal metaplasia in prior biopsy material available in our unit, and 2 had intestinal metaplasia in an esophagectomy that followed the EMR. The single patient in whom no intestinal metaplasia was found, neither in biopsies nor in EMR, and who did not undergo an esophagectomy had been under surveillance for Barrett esophagus for over 20 years. We conclude that the frequent absence of residual intestinal metaplasia around an adenocarcinoma in an EMR specimen is the result of sampling error. When evaluated in depth by looking at history, biopsies preceding the EMR, and esophagectomy following the EMR, all of these patients with adenocarcinoma had intestinal metaplasia in their columnar-lined esophagus. This indicates that intestinal metaplasia is a necessary precursor to adenocarcinoma of the esophagus.

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Source
http://dx.doi.org/10.1097/PAS.0000000000000601DOI Listing

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