Gastroenterology

Gastroenterology

Volume 119, Issue 3, September 2000, Pages 683-690
Gastroenterology

Alimentary Tract
Cytokeratin immunoreactivity patterns in the diagnosis of short-segment Barrett's esophagus

https://doi.org/10.1053/gast.2000.16482Get rights and content

Abstract

Background & Aims: The origin of intestinal metaplasia in short segments of columnar mucosa at the esophagogastric junction has clinical importance but can be difficult to determine at endoscopy. Cytokeratin (CK) 7 and 20 patterns are specific for long-segment Barrett's esophagus; however, their utility in short-segment Barrett's esophagus has not been assessed. Methods: Endoscopic biopsy specimens from patients with long-segment Barrett's esophagus (n = 49), suspected short-segment Barrett's esophagus (n = 43), and gastric intestinal metaplasia (n = 26) were immunostained for CK7 and CK20. Comprehensive clinical data were obtained, including age, gender, and hiatal hernia and Helicobacter pylori status. Results: A Barrett's CK7/20 pattern was present in 48 (98%) of 49 patients with long-segment Barrett's esophagus, 35 (82%) of 43 with suspected short-segment Barrett's esophagus, and 0 (0%) of 26 patients with gastric intestinal metaplasia. Patients with suspected short-segment Barrett's esophagus with a Barrett's CK7/20 pattern were clinically similar to those with long-segment Barrett's esophagus. In contrast, patients with suspected short-segment Barrett's esophagus with no Barrett's CK7/20 pattern were clinically similar to those with gastric intestinal metaplasia. Conclusions: A Barrett's CK7/20 pattern identifies a subset of patients with suspected short-segment Barrett's esophagus who have a patient profile similar to that seen in long-segment Barrett's esophagus. A Barrett's CK7/20 pattern is an objective marker of Barrett's mucosa that in conjunction with appropriate clinical and endoscopic data can be used by clinicians to better define patients with short-segment Barrett's esophagus.

GASTROENTEROLOGY 2000;119:683-690

Section snippets

Patient selection

Patients with suspected short-segment Barrett's esophagus, long-segment Barrett's esophagus, and gastric intestinal metaplasia were identified from the files of The Cleveland Clinic Foundation spanning a 3-year period (1996–1998). Short-segment Barrett's esophagus was defined endoscopically as tongues and/or circumferential columnar-appearing mucosa <3 cm above the proximal margin of the gastric folds, with intestinal metaplasia identified on biopsy specimens obtained from the area of suspected

Cohort characteristics, exclusions, and interobserver agreement

A total of 127 patients were evaluated. Biopsy specimens from 7 patients were considered inadequate because of poor orientation and were excluded from the evaluation. Interobserver agreement between the 2 gastrointestinal pathologists in the remaining 120 cases was excellent (κ = 0.95), with only 2 discrepant cases, leaving a total 118 patients for evaluation.

Overall, 49 patients with long-segment Barrett's esophagus, 43 patients with suspected short-segment Barrett's esophagus, and 26 patients

Discussion

Barrett's esophagus is the single most important risk factor for the development of esophageal dysplasia and carcinoma25, 26, 27, 28; consequently, strategies to prevent esophageal adenocarcinoma have focused on early recognition of specialized columnar mucosa with subsequent regular endoscopic surveillance. Historically, Barrett's esophagus referred to the presence of long areas of esophageal columnar mucosa (>3 cm proximal to the esophagogastric junction), now known as long-segment Barrett's

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      However, none of these criteria have been systematically applied to show the degree of reproducibility in foveolar-type dysplasia of the oesophagus and the stomach. Previous studies on dysplasia (adenomatous-type) in Barrett's oesophagus have shown imperfect inter-observer reproducibility with lack of reproducibility especially prevalent at the low end of the spectrum with ‘indefinite’ and ‘low-grade’ categories.1,6,7 On the other hand, a recent study showed an over-diagnosis of high-grade dysplasia in Barrett's oesophagus with confirmed high-grade dysplasia in only 51% of the cases reviewed.8

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    Address requests for reprints to: Terry L. Gramlich, M.D., The Cleveland Clinic Foundation, 9500 Euclid Avenue L25, Cleveland, Ohio 44195. e-mail: [email protected]; fax: (216) 445-6967.

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