Minireviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Aug 6, 2016; 7(3): 406-411
Published online Aug 6, 2016. doi: 10.4292/wjgpt.v7.i3.406
Clinical significance and management of Barrett’s esophagus with epithelial changes indefinite for dysplasia
Prashanthi N Thota, Gaurav Kistangari, Ashwini K Esnakula, David Hernandez Gonzalo, Xiu-Li Liu
Prashanthi N Thota, Gaurav Kistangari, Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States
Ashwini K Esnakula, David Hernandez Gonzalo, Xiu-Li Liu, Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL 32610-0275, United States
Author contributions: All authors have contributed to conception and design of the study, data acquisition and interpretation and drafting and critical revision of the manuscript; all authors approve the final manuscript.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xiu-Li Liu, MD, PhD, Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, P.O. Box 100275, 1600 SW Archer Road, Gainesville, FL 32610-0275, United States. xiuliliu@ufl.edu
Telephone: +1-352-6279257 Fax: +1-352-6279242
Received: April 18, 2016
Peer-review started: April 18, 2016
First decision: May 17, 2016
Revised: May 27, 2016
Accepted: June 27, 2016
Article in press: June 29, 2016
Published online: August 6, 2016
Processing time: 105 Days and 10.4 Hours
Abstract

Barrett’s esophagus (BE) is defined as the extension of salmon-colored mucosa into the tubular esophagus ≥ 1 cm proximal to the gastroesophageal junction with biopsy confirmation of intestinal metaplasia. Patients with BE are at increased risk of esophageal adenocarcinoma (EAC), and undergo endoscopic surveillance biopsies to detect dysplasia or early EAC. Dysplasia in BE is classified as no dysplasia, indefinite for dysplasia (IND), low grade dysplasia (LGD) or high grade dysplasia (HGD). Biopsies are diagnosed as IND when the epithelial abnormalities are not sufficient to diagnose dysplasia or the nature of the epithelial abnormalities is uncertain due to inflammation or technical issues. Specific diagnostic criteria for IND are not well established and its clinical significance and management has not been well studied. Previous studies have focused on HGD in BE and led to changes and improvement in the management of BE with HGD and early EAC. Only recently, IND and LGD in BE have become focus of intense study. This review summarizes the definition, neoplastic risk and clinical management of BE IND.

Keywords: Barrett’s esophagus; Dysplasia; Progression; Biomarkers; Esophageal adenocarcinoma; Indefinite for dysplasia

Core tip: Barrett’s esophagus (BE) with indefinite for dysplasia (IND) is diagnosed when the epithelial abnormalities are not sufficient to diagnose dysplasia or the nature of the epithelial abnormalities is uncertain due to inflammation. The risk of prevalent neoplasia in BE with IND varies between 1.9% and 15%. The progression to advanced neoplasia reported varies from 0.43 to 1.2 cases per 100 person-years at risk. Predictors such as the length of BE segment, multi-focality of BE IND, age > 60 years, abnormal p53 expression, active inflammation, and abnormal DNA content as detected by flow cytometry may help in risk-stratifying this patient population.