Diagnosis
What does BE look like on endoscopy?
Salmon-colored tongues extending from the GEJ
True or false, alcohol is a risk factor for BE
False
How many pathologists are required to diagnose dysplasia?
2 with one of them having expertise in GI
True or false
anti-reflux surgery is an anti-neoplastic measure for patients with BE
False
True or fale, wine is possibly a protective factor for BE
True
Intestinal metaplasia (columnar, goblet cells)
Name 3 known risk factors for BE
>5 yrs of GERD
>50 yrs old
Male
Caucasian
Smoking
Central obesity
What is the timing of surveillance for patients without dysplasia?
3-5 years
What is the therapy for adenocarcinoma that is limited to the mucosa
Endoscopic ablation
How long is long BE?
>3cm
How many biopsies are to be taken when diagnosing BE on endoscopy?
8
What population do you typically not screen for BE
Females
What two options are available for a patient with low-grade dysplasia?
Surveillance in 1 year
Endoscopic therapy
What is the therapy for adenocarcinoma that extends into the submucosa?
Multi-disciplinary discussion. Patient may be a candidate for endoscopic therapy. Patient may need neoadjuvant chemo and surgery
What is the annual risk of cancer for patients with high grade dysplasia (within 2 percent)?
0.7%
What is the minimum number of biopsies on endoscopy to diagnose BE?
4 per cm of circumferential BE, 1 per cm of tongues
What is an alternative screening method for BE besides traditional endoscopy?
Unsedated transnasal endoscopy
How are patient's biopsied during surveillance? (for patients with known dysplasia, and patients without dysplasia)
Four quadrant biopsy
Dysplasia - 1 cm intervals
Without - 2 cm
What is the treatment method for nodular BE
endoscopic mucosal resection
This Australian thoracic surgeon first describe BE in 1950
Norman Barrett
Patient's with clinical suspicion of BE but lack metaplasia after biopsy, what is next?
Repeat endoscopy in 1-2 years
If esophagitis is encountered during endoscopy, what do you do next?
PPI 8-12 weeks then repeat endoscopy
If a patient has indefinite dysplasia on biopsy, what next?
Repeat in 3-6 months after optimizing PPI
If again indefinite repeat in 1 year
What is an alternative therapy to nodular dysplatic BE?
radiofrequency ablation
What is the annual risk of cancer for patients with high grade dysplasia (within 2 percent)?
7%