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Barrett Esophagus : Dysplasia Assessment

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Dysplasia Assessment in Barrett Esophagus (BE): Pitfalls

  • Separation of low-grade dysplasia (LGD) from reactive changes seen in reflux esophagitis can be difficult.
  • The interobserver agreement for the diagnosis of LGD is less than 50%.
  • The interobserver agreement is about 85% for the diagnosis of high-grade dysplasia (HGD).
  • Dysplasia causes only subtle or no endoscopic abnormalities. Recent advances in endoscopy such as narrow band imaging have aided in identification of dysplastic foci during real-time endoscopy.
  • Dysplasia is often patchy in extent and severity, causing significant sampling errors with the 4-quadrant biopsy approach used by the endoscopists. In older studies of patients who underwent esophagectomy due to a diagnosis of HGD on biopsies, about 13% of cases showed invasive adenocarcinoma that was missed on biopsies.
About this image: Low magnification view of Barrett esophagus. Note the columnar epithelium on the right and cardiac-type glands in the lamina propria. The glands on the left underneath the squamous epithelium have low-grade dysplasia.

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