The Natural History of Barrettʼs Dysplasia and Adenocarcinoma: 498

Raja Shekhar R. Sappati Biyyani, M.D., Internal Medicine Resident (PGY-3), Canton Medical Education Foundation, Canton, Ohio. Linda Chessler, Research Associate, Mercy Medical Center, Canton, Ohio. James F. King, M.D., MACG, FACP. Professor of Medicine, GI Section, North Eastern Ohio Universities College of Medicine, Mercy Medical Center, Canton, Ohio. The natural history of Barrett’s esophagus (BE) is a matter of debate in the gastrointestinal literature. We report two unique presentations of BE, which demonstrate highly variable biologic behavior. This poses a management dilemma when faced with options of surveillance, surgery or ablation modalities. These cases suggest, advancement from HGD to BEAC is not always rapid and the cancer can have variable biologic behavior. We report two interesting cases wherein one developed poorly differentiated adenocarcinoma and the other developed changes approaching adenocarcinoma. Both remained asymptomatic and died of non-gastrointestinal causes. These cases demonstrate the fact that, patients often do not die from BE or BEAC but most often from concurrent cardiovascular disease. The surveillance endoscopies appear to have made little difference in the quality or duration of their lives. Raja Shekhar R. Sappati Biyyani Linda Chessler James F. King