OMED E-Newsletter Issue 8, 2009: NYSGE Syllabus
Advanced Imaging in Barrett's Esophagus
By Prateek Sharma, M.D.
The New York Society for Gastrointestinal Endoscopy is the largest regional GI endoscopy society in the United States. The Society is dedicated to the teaching and advancement of gastrointestinal endoscopy. The society runs numerous programs throughout the year, including an annual fellow’s endoscopy course each summer, and a major postgraduate endoscopy conference each fall. The next course will be held in New York from December 16-19, 2009.
Each month a syllabus entry from the 32nd Annual New York Society for Gastrointestinal Endoscopy Course can be accessed here. This month the entry is entitled ‘Advanced Imaging in Barrett's Esophagus’ By Prateek Sharma, M.D.
Barrett's Esophagus (BE) is a metaplastic change in the esophagus that results in replacement of the normal squamous lined epithelium with intestinal metaplasia. The incidence of esophageal adenocarcinoma has rapidly increased in recent years and BE has been found to be present as a precursor lesion in many of these cases. Patient's with BE are thought to have an annual risk of developing esophageal cancer of 0.5% per year, substantially higher than the general population, but the absolute risk of developing cancer in BE patients is low.
Endoscopic screening of subjects with chronic reflux symptoms has been recommended as a method of detecting BE and early cancer and despite the lack of clinical evidence, BE patients are then routinely enrolled in surveillance programs.
Diagnosis of BE
Endoscopic assessment of the extent of Barrett's esophagus (endoscopically visible esophageal columnar mucosa) is dependent on correctly locating esophageal landmarks such as the gastroesophageal junction (GEJ). Lack of simple, standardized criteria for identifying these landmarks and reliably measuring the extent of Barrett's esophagus has hindered consistency in research and clinical practice. Accordingly, a variety of ad hoc and frequently inadequately specified and validated approaches have been used. For instance, grading of patients into those with variably defined 'short' and 'long' segments of BE is an unsatisfactorily crude approach. An international Barrett's esophagus working group was convened to standardize the endoscopic measurement of Barrett's esophagus. The working group developed criteria to assess the circumferential and the maximal extent of esophageal columnar tissue, the Prague C and M criteria. Using these criteria, circumferential Barrett's esophagus extending to 3 cm above the GEJ with a tongue extending 5 cm above the GEJ would be described as C3M5, while a tongue extending 3 cm above the GEJ with no circumferential extent of Barrett's esophagus would be designated C0M3.
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