Barrett Esophagus

Published on 18/07/2015 by admin

Filed under Radiology

Last modified 18/07/2015

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 Due to more severe reflux disease

image Hiatal hernia in almost all patients
image Mid esophageal mucosal irregularity, stricture, deep ulceration
image Risk of cancer > short-segment type
• Short segment: Columnar epithelium ≤ 3 cm above GE junction

image More common than long segment (reported in 2-12% of patients with chronic reflux at endoscopy)
image Due to less severe reflux disease
image Distal esophageal reticular mucosa, ± stricture, ± shallow ulceration

TOP DIFFERENTIAL DIAGNOSES

• Esophageal carcinoma
• Reflux esophagitis
• Candida esophagitis
• Viral esophagitis
• Radiation esophagitis
• Caustic esophagitis
• Drug-induced esophagitis
• Scleroderma

CLINICAL ISSUES

• Risk of adenocarcinoma based on morphology

image High risk: Midesophageal stricture, ulcer, reticular mucosa
image Moderate risk: Distal peptic stricture and reflux esophagitis
image Low risk: If none of above findings are present
• Diagnosis: Endoscopy with biopsy
image
(Left) Graphic shows a type 1 hiatal hernia, distal esophageal stricture, and nodular mucosal surface. Note the discrete ulcer image and an adenocarcinoma image represented by a raised sessile lesion with an irregular surface.

image
(Right) 2 views from an esophagram show a mid esophageal stricture image and ulcer in a patient with a small hernia image and reflux.
image
(Left) Endoscopic image shows a large ulcer image with the velvet texture of Barrett mucosa and stricture. Normal esophageal mucosa has a shiny, smooth, pink surface.

image
(Right) Two views from an esophagram show a polypoid mass image that represents an adenocarcinoma arising in Barrett mucosa.

TERMINOLOGY

Definitions

• Metaplasia of distal esophageal squamous epithelium to columnar epithelium

IMAGING

General Features

• Best diagnostic clue

image Mid esophageal stricture with hiatal hernia and reflux is essentially pathognomonic
• Other general features

image Acquired condition due to reflux esophagitis
image Premalignant condition associated with increased risk of esophageal adenocarcinoma

– Risk: 30-40x higher than in general population
– 90-100% of adenocarcinomas arise from Barrett mucosa

Radiographic Findings

• Double contrast esophagography is imaging of choice
• Classified into 2 types based on endoscopy and histopathologic findings

image Long segment: Columnar epithelium > 3 cm above gastroesophageal (GE) junction

– Due to more severe reflux disease

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