Directional distribution of neoplasia in Barrett's esophagus is not influenced by distance from the gastroesophageal junction

Background: Accurate endoscopic detection and staging are critical for appropriate management of Barrett's esophagus (BE)-associated neoplasia. Prior investigation has demonstrated that the distribution of endoscopically detectable early neoplasia is not uniform but instead favors specific directional distributions within a short BE segment; however, it is unknown whether the directional distribution of neoplasia differs with increasing distance from the gastroesophageal junction, including in patients with long-segment BE.

Objective: To identify whether directional distribution of BE-associated neoplasia is influenced by distance from the gastroesophageal junction.

Design: Retrospective cohort study.

Setting: Tertiary-care referral center.

Patients: Patients with either short-segment or long-segment BE undergoing EMR.

Intervention: EMR.

Main outcome measurements: Directional distribution of BE-associated neoplasia stratified by distance from gastroesophageal junction.

Results: EMR was performed on 60 lesions meeting study criteria during the specified time period. Pathology demonstrated low-grade dysplasia in 22% (13/60), high-grade dysplasia in 38% (23/60), intramucosal (T1a) adenocarcinoma in 23% (14/60), and invasive (≥ T1b) adenocarcinoma in 17% (10/60). Directional distribution of lesions was not uniform (P < .001), with 62% of lesions (37/60) located between the 1 o'clock and 5 o'clock positions. When circular statistics methodology was used, there was no difference in the directional distribution of neoplastic lesions located within 3 cm of the gastroesophageal junction compared with ≥ 3 cm from the gastroesophageal junction.

Limitations: Single-center study may limit external validity.

Conclusion: The directional distribution of neoplastic foci within a BE segment is not influenced by distance of the lesion from the gastroesophageal junction. Mucosa between the 1 o'clock and 5 o'clock locations merits careful attention and endoscopic inspection in individuals with both short-segment BE and long-segment BE.