Recent advances in Barrett's esophagus: short-segment Barrett's esophagus and cardia intestinal metaplasia.

Abstract

The recent rapid increase in the incidence of adenocarcinoma of the distal esophagus and the gastric cardia has generated significant interest in the premalignant lesion, Barrett's esophagus. The traditional definition of Barrett's esophagus included the presence of 3 cm or greater of columnar mucosa in the distal esophagus. Studies have clarified that intestinal metaplasia was not only the most common and distinctive type of epithelium detected within the columnar mucosa, but also the one with greatest malignant potential; therefore, Barrett's esophagus has come to be defined by the histological presence of intestinal metaplasia. Previous studies evaluating the association of esophageal adenocarcinoma with Barrett's esophagus have only included patients with traditional or long-segment Barrett's esophagus. However, recent studies have suggested that dysplasia and adenocarcinoma can also be associated with short-segment Barrett's esophagus (SSBE), ie, less than 3 cm of columnar mucosa. Data are also emerging regarding the significance of intestinal metaplasia detected in biopsy specimens obtained immediately below the gastroesophageal junction, ie, from the gastric cardia. However, the premalignant potential of cardia intestinal metaplasia (CIM) is unknown at this time. Although the exact incidence of adenocarcinoma in SSBE is not known, endoscopic surveillance of such patients, although controversial, appears to be prudent at this time. With the currently available information, routine biopsy of a normal-appearing squamocolumnar junction is not advocated. This review critically evaluates and summarizes recent data on SSBE and CIM.