Diagnosis

^^ Endoscopic diagnostic criteria (Fig. 3.28)

► Reddened columnar epithelium lining the full circumference of the esophagus

► Squamocolumnar junction located at least 3 cm above the esophageal hiatus

► Frequent tonguelike extensions, occasional islands of epithelium

► "Short Barrett" = epithelial boundary shifted 2 cm proximally

Differential diagnosis

► Barrett carcinoma

Checklist for endoscopic evaluation

► Distance of the squamocolumnar junction from the incisors

► Location of the esophageal hiatus

► Epithelial islands in the proximal esophagus?

► Incompetent cardia?

► Fresh inflammatory changes?

Additional Studies

► See Management

Comment

Barrett epithelium is frequently missed at endoscopy. Adenocarcinoma, which develops in up to 10 % of patients with Barrett esophagus, is also frequently missed on gross inspection. Dysplasia can be diagnosed only by histological examination.

Fig. 3.28 Barrett epithelium a The entire circumference of the distal esophagus is lined with metaplastic columnar epithelium

Fig. 3.28 Barrett epithelium a The entire circumference of the distal esophagus is lined with metaplastic columnar epithelium

The squamocolumnar junction has migrated to a level 32 cm from the incisors c Barrett epithelium with ulceration b

The squamocolumnar junction has migrated to a level 32 cm from the incisors c Barrett epithelium with ulceration

d "Short Barrett": the squamocolumnar junction has migrated by approximately 3 cm

e Early adenocarcinoma d "Short Barrett": the squamocolumnar junction has migrated by approximately 3 cm e Early adenocarcinoma b

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