Length of the Barrett’s Esophagus Is Proportional to the Abnormality of Esophageal Motility and Anti-reflux Barrier
Abstract
c 2023 The Korean Society of Neurogastroenterology and Motility J Neurogastroenterol Motil, Vol. 29 No. 1 January, 2023 www.jnmjournal.org The Barrett’s esophagus (BE) is the premalignant condition of esophageal adenocarcinoma. BE is characterized by the replacement of normal esophageal squamous cell epithelium with columnar metaplasia. BE results from reflux of gastric contents into the esophagus, resulting in inflammation and chronic tissue injury. Diagnosis of BE requires both endoscopic and histologic documentation of columnar epithelium with intestinal metaplasia extending into the tubular esophagus ≥ 1 cm proximal to the esophagogastric junction. The progression from BE to the esophageal adenocarcinoma is believed to be a continuous sequence, from nondysplastic BE, followed by low grade dysplasia, then high grade dysplasia, and eventually esophageal adenocarcinoma. BE segment length is potentially correlated with risk of progression from BE to esophageal adenocarcinoma. Meta-analysis and systematic review of the BE comparing progression rates to esophageal adenocarcinoma or to high grade dysplasia combined demonstrate significantly lower rates in patients with short segment BE (SSBE) compared with long segment BE (LSBE). Current American College of Gastroenterology guideline recommends that the length of the nondysplastic BE segment be considered when assigning surveillance intervals such that LSBE (≥ 3 cm) are evaluated with endoscopy every 3 years, while SSBE (< 3…
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