The document discusses the pathology of the gastric cardia and Barrett's esophagus. It outlines the normal anatomy of the gastroesophageal junction and describes endoscopic biopsy surveillance. Various stages of dysplasia in Barrett's esophagus are shown, from none to high grade dysplasia and intramucosal carcinoma. Biomarkers like ploidy, TP53, and methylation are discussed for risk stratification. Guidelines for follow up of Barrett's esophagus based on dysplasia grade are provided.

1. Mucosal Pathology of Gastric
Cardia and Barrett’s oesophagus

3. Gastro-esophageal junction

4. Endoscopic Biopsy Surveillance

5. Normal esophagus

6. Normal gastric cardia

7. Gastric fundus

8. Oesophageal biopsy origin
• Oesophageal submucosal glands
or ducts,
• Native squamous epithelium
• Multilayered epithelium

9. Goblet cell mimickers

10. Alcian blue stain,at pH2.5

11. Grading dysplasia in Barrett’s
esophagus algorithm
• Surface maturation compared to
underlying glands
• Architecture of the glands
• Cytologic features
• Inflammation and erosions/ulcers

12. Barretts Esophagus, No dysplasia

13. Indefinite

14. Barretts Esophagus,low grade

15. Low grade,tubular adenoma

16. High grade

17. Intramucosal carcinoma

18. Invasive carcinoma

19. Narrow band imaging

20. Autofluorescence

21. Cofocal laser endomicroscopy

22. BIOMARKERS FOR RISK
STRATIFICATION
• PLOIDY
• TP53
• Aberrant tumour suppressor gene promoter
methylation

23. 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