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Barrett’s esophagus

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barrets esophagus

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Barrett’s esophagus

  1. 1. Mucosal Pathology of Gastric Cardia and Barrett’s oesophagus
  2. 2. Gastro-esophageal junction
  3. 3. Endoscopic Biopsy Surveillance
  4. 4. Normal esophagus
  5. 5. Normal gastric cardia
  6. 6. Gastric fundus
  7. 7. Oesophageal biopsy origin • Oesophageal submucosal glands or ducts, • Native squamous epithelium • Multilayered epithelium
  8. 8. Goblet cell mimickers
  9. 9. Alcian blue stain,at pH2.5
  10. 10. Grading dysplasia in Barrett’s esophagus algorithm • Surface maturation compared to underlying glands • Architecture of the glands • Cytologic features • Inflammation and erosions/ulcers
  11. 11. Barretts Esophagus, No dysplasia
  12. 12. Indefinite
  13. 13. Barretts Esophagus,low grade
  14. 14. Low grade,tubular adenoma
  15. 15. High grade
  16. 16. Intramucosal carcinoma
  17. 17. Invasive carcinoma
  18. 18. Narrow band imaging
  19. 19. Autofluorescence
  20. 20. Cofocal laser endomicroscopy
  21. 21. BIOMARKERS FOR RISK STRATIFICATION • PLOIDY • TP53 • Aberrant tumour suppressor gene promoter methylation
  22. 22. Follow up of Barrett’s esophagus Dysplasia grade Documentation Followup None Two EGDs with biopsy 3yr Low grade Highest grade on repeat 1yr until no dysplasia High grade Repeat endoscopy to exclude cancer ,expert confirmation Every 3 month

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