Histologic evaluation of resection specimens obtained at 293 endoscopic resections in Barrett's esophagus

Gastrointest Endosc. 2008 Apr;67(4):604-9. doi: 10.1016/j.gie.2007.08.039. Epub 2007 Dec 26.


Background: Evidence-based selection criteria for endoscopic resection (ER) of Barrett's neoplasia are scarce.

Objective: To study the histopathology of ER specimens of Barrett's neoplasia and correlate this with endoscopic characteristics to make recommendations for patient management. DESIGN, SETTING, INTERVENTIONS: Histology and correlating endoscopy reports of specimens obtained at 293 consecutive ERs performed at a Dutch tertiary referral center between 2000 and 2006 were reviewed.

Main outcome measurements: Histologic findings in ER specimens and their relation with endoscopic characteristics.

Results: A total of 150 ERs were performed for focal lesions: 16% type 0-I, 23% 0-IIa, 7% 0-IIb, 3% 0-IIc, 9% 0-IIa-IIb, and 42% 0-IIa-IIc; and 143 for flat mucosa. Histology revealed no dysplasia in 57 ERs, low-grade intraepithelial neoplasia in 52, high-grade intraepithelial neoplasia in 104, T1m in 61, and T1sm in 17; in two cancers, infiltration depth was not assessable because of artifacts. Type 0-I and 0-IIc lesions significantly more often penetrated the submucosa (P = .009): 60% were G1 cancers, 23% were G2 cancers, and 18% were G3 cancers. G2-G3 cancers significantly more often invaded the submucosa (P < .001) or had positive vertical margins (P = .015). Histology of ER specimens led to a change in diagnosis in 49% of the focal lesions and a relevant change in treatment policy in 30%.

Limitations: A retrospective study.

Conclusions: ER is a valuable diagnostic tool that frequently leads to a change in treatment policy. Most endoscopically resected early Barrett's neoplasia are 0-II type, G1 mucosal neoplasia. Submucosal infiltration is more often encountered in type 0-I and 0-IIc lesions and in G2-G3 cancers.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Barrett Esophagus / pathology*
  • Barrett Esophagus / surgery
  • Carcinoma / pathology*
  • Carcinoma / surgery
  • Endoscopy, Gastrointestinal / methods*
  • Esophageal Neoplasms / pathology*
  • Esophageal Neoplasms / surgery
  • Humans
  • Intestinal Mucosa / pathology
  • Intestinal Mucosa / surgery
  • Neoplasm Invasiveness / pathology
  • Neoplasm Staging
  • Precancerous Conditions
  • Prognosis
  • Retrospective Studies