Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2013; 5(12): 590-594
Published online Dec 16, 2013. doi: 10.4253/wjge.v5.i12.590
Endoscopic mucosal resection of Barrett’s esophagus detects high prevalence of subsquamous intestinal metaplasia
Patrick Yachimski, Chanjuan Shi, James C Slaughter, Mary Kay Washington
Patrick Yachimski, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN 37232-5280, United States
Chanjuan Shi, Mary Kay Washington, Department of Pathology, Microbiology and Immunology Vanderbilt University Medical Center, Nashville, TN 37232-5280, United States
James C Slaughter, Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37232-5280, United States
Author contributions: Yachimski P designed the study; Shi C and Washington MK was performed histopathology analysis; Slaughter JC was performed statistical analysis; Yachimski P drafted the manuscript; all authors was reviewed and revised for submission final manuscript.
Correspondence to: Patrick Yachimski, MD, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, 1660 the Vanderbilt Clinic, Nashville, TN 37232-5280, United States. patrick.yachimski@vanderbilt.edu
Telephone: +1-615-3229654 Fax: +1-615-3437174
Received: October 1, 2013
Revised: November 14, 2013
Accepted: December 9, 2013
Published online: December 16, 2013
Processing time: 80 Days and 20 Hours
Abstract

AIM: To report the prevalence of Subsquamous intestinal metaplasia (SSIM) in patients undergoing endoscopic mucosal resection (EMR) for staging of Barrett’s esophagus (BE).

METHODS: Thirty-three patients with BE associated neoplasia underwent EMR at our institution between September 2009 and September 2011; 22 of these patients met study inclusion criteria. EMR was targeted at focal abnormalities within the BE segment. EMR was performed in standardized fashion using a cap-assisted band ligation technique, and resection specimens were assessed for the presence of SSIM. Demographic and clinical data were analyzed to determine predictors of SSIM.

RESULTS: SSIM was detected in 59% of patients. SSIM was detected in 73% of patients with short segment (< 3 cm) BE, and in 45% of patients with long-segment (≥ 3 cm) BE (P = NS). There was no association between presence/absence of SSIM and age, gender, or stage of BE-associated neoplasia.

CONCLUSION: EMR detects SSIM in a majority of patients with BE-associated neoplasia. While the long-term clinical significance of SSIM remains uncertain, these results highlight the importance of EMR as an optimal diagnostic tool for staging of BE and detection of SSIM, and should further limit concerns that SSIM is purely a post-ablation phenomenon.

Keywords: Barrett esophagus; Barrett epithelium; Endoscopy; Esophageal cancer; Pathology

Core tip: Subsquamous intestinal metaplasia (SSIM) is the term used to describe glandular Barrett’s tissue which is buried beneath overlying squamous mucosa and not visible endoscopically. Esophageal forceps which fail to contain lamina propria are of insufficient depth to assess for the presence of SSIM. This study of patients with Barrett’s esophagus (BE) undergoing endoscopic mucosal resection, previously naïve to endoscopic therapy, detected SSIM in 59% of patients. These findings demonstrate that SSIM is a common occurrence in the natural history of BE, and should limit concerns that SSIM is purely a post-ablation phenonomenon.