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.
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.
Authors: Cary C Cotton; W Asher Wolf; Sarina Pasricha; Nan Li; Ryan D Madanick; Melissa B Spacek; Kathleen Ferrell; Evan S Dellon; Nicholas J Shaheen Journal: Gastrointest Endosc Date: 2015-03-24 Impact factor: 9.427
Authors: Benjamin Michael Allanson; Jessica Bonavita; Bob Mirzai; Tze Sheng Khor; Spiro C Raftopoulos; Willem Bastiaan de Boer; Ian S Brown; Marian Priyanthi Kumarasinghe Journal: Mod Pathol Date: 2017-05-26 Impact factor: 7.842
Authors: Cary C Cotton; Lucas C Duits; W Asher Wolf; Anne F Peery; Evan S Dellon; Jacques J Bergman; Nicholas J Shaheen Journal: Am J Gastroenterol Date: 2015-09-08 Impact factor: 10.864