Barrett's Esophagus (cont.)

When patients with Barrett's esophagus are assessed as a group, the risk of cancer has been found to be as low as one in 300 patients yearly. This means that if we examined 300 patients yearly, one patient would be found to have cancer every year. What we really need to know, however, is the risk of cancer if NO DYSPLASIA is found after one or two years of surveillance. Our belief is that this risk would be much less than the previously-quoted figures of one in 300 patients yearly.

Among patients with high grade dysplasia, up to 50% may be found to have cancer. Therefore, the first order of management when high grade dysplasia is found is to exclude the presence of an adenocarcinoma.

Low grade dysplasia is much less threatening than high grade dysplasia, but we don't know just how much less. In fact, we don't have precise data to indicate just what the cancer risk is in patients with Barrett's and low grade dysplasia.

The diagnosis of dysplasia should be as precise as possible because this diagnosis can prompt a change in the treatment or the intensity of follow-up of patients with Barrett's esophagus. It requires a great deal of experience to be able to make a precise diagnosis of the presence and grade of dysplasia. Therefore, it is a common and useful practice to ask a second pathologist (or even a third, if necessary) to review the biopsies. The idea is to see if there is an agreement between the pathologists and/or to get a more experienced opinion about the presence and grade of dysplasia.

If a person has longer segment Barrett's, one would guess that the cancer risk is greater than with shorter segment Barrett's. The data, however, is controversial in this regard. For that reason, the current practice is to do endoscopic biopsy surveillance with similar frequency in patients with short and long segment Barrett's esophagus.

Source: MedicineNet.com
http://www.medicinenet.com/barretts_esophagus/article.htm