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Resection of at least 1 cm suggested for patients with neoplastic BE
Neoplastic Barrett’s esophagus should be resected at least 1 cm into the squamous epithelium to ensure complete eradication of subsquamous intestinal metaplasia, according to recent study results.
Researchers conducted a retrospective study of the resection specimens from 110 patients (mean age, 66 years; 84% men) with neoplastic Barrett’s esophagus (BE) between 2004 and 2010. Two pathologists in Germany analyzed all samples. In all, 506 specimens were acquired through endoscopic mucosal resection (EMR). After endotherapy, 138 specimens containing squamous epithelium (SQE) were studied to determine the frequency of subsquamous intestinal metaplasia (SSIM).
Eighty-nine percent of the samples contained SSIM that extended across 98% of the cohort. The average length of SSIM was 3.3 mm, with a range of 0.2 to 9.6 mm. Twenty-five percent of SSIM were at least 5 mm in length.
Researchers said the length of SSIM was comparable to that of BE (P<.05), and 60.1% of the SQE specimens contained SSIM with neoplasia of varying grades.
“Our data do provide evidence for a regular extension of BE along the proximal and/or marginal borders of visible BE and SQE regardless of its neoplastic stage,” the researchers concluded. “Therefore it seems to be justified to extend random biopsies for BE surveillance as well as endoscopic resection and/or ablation to 1 or even 1.5 cm proximal of the Z line and beyond the lateral borders of BE tongues.”
Disclosure: The researchers report no relevant financial disclosures.