Relationship of Barretts esophagus to esophageal cancer
Barrett’s columnar-lined esophagus is an acquired condition of the distal esophagus occurring in 10% to 15% of individuals with chronic GE reflux and in 6.8% of the general population. The incidence of adenocarcinoma increases nearly fortyfold in patients with Barrett’s esophagus. It is estimated that 5% of patients with Barrett’s esophagus will eventually develop invasive cancer , and patients with histologically proven Barrett’s esophagus require lifelong surveillance with endoscopic four-quadrant biopsies every 2 cm (1 cm if known dysplasia) because of this risk. It is also important that two different pathologists review the slides to increase the yield of the histologic diagnosis per the American Gastroenterological Association 2011 guidelines. It is generally believed that disease progresses from Barrett’s metaplasia to low-grade dysplasia to high-grade dysplasia (HGD) to adenocarcinoma.