Mucosal Pathology of Gastric Cardia and Barrett’s oesophagus

Gastro-esophageal junction

Endoscopic Biopsy Surveillance

Normal esophagus

Normal gastric cardia

Gastric fundus

Oesophageal biopsy origin

• Oesophageal submucosal glands or ducts,

• Native squamous epithelium

• Multilayered epithelium

Goblet cell mimickers

Alcian blue stain,at pH2.5

Grading dysplasia in Barrett’s esophagus algorithm

• Surface maturation compared to underlying glands

• Architecture of the glands

• Cytologic features

• Inflammation and erosions/ulcers

Barretts Esophagus, No dysplasia

Indefinite

Barretts Esophagus,low grade

Low grade,tubular adenoma

High grade

Intramucosal carcinoma

Invasive carcinoma

Narrow band imaging

Autofluorescence

Cofocal laser endomicroscopy

BIOMARKERS FOR RISK STRATIFICATION

• PLOIDY

• TP53

• Aberrant tumour suppressor gene promoter methylation

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