Is Barrett's metaplasia the source of adenocarcinomas of the cardia?

G. W B Clark, Thomas Christopher Smyrk, P. Burdiles, S. F. Hoeft, J. H. Peters, M. Kiyabu, R. A. Hinder, C. G. Bremner, T. R. DeMeester

Research output: Contribution to journalArticle

276 Citations (Scopus)

Abstract

Objective: To investigate the prevalence of Barrett's esophagus in patients with adenocarcinomas located at the gastroesophageal junction. Design: A case series of patients who underwent esophagogastrectomy for adenocarcinoma was retrospectively reviewed. Tumors were grouped by location as esophageal, cardiac, and subcardiac, and the prevalence of specialized intestinal metaplasia in the histological specimens was determined. Setting: A university department of surgery that specializes in esophageal diseases. Patients: One hundred patients with adenocarcinoma of the esophagus, cardia, or proximal stomach. Main Outcome: Cardiac adenocarcinomas were associated with Barrett's esophagus in 42% of the patients. Results: Specialized intestinal metaplasia was identified in the histological sections from the resected specimen in 42% (13/31) of cardiac adenocarcinomas and in 79% (38/48) of esophageal adenocarcinomas but in only 5% (1/21) of subcardiac adenocarcinomas. The preoperative endoscopic biopsy results concurred with the final diagnosis of Barrett's esophagus in 33 of the 38 esophageal tumors, six of the 13 cardiac tumors, and the one subcardiac tumor but failed to detect specialized intestinal metaplasia in 54% (7/13) of cardiac tumors. Cardiac tumors were associated with shorter lengths of Barrett's mucosa than esophageal tumors (2.7 ± 1.8 cm vs 7.4 ± 3.4 cm, P<.01). The Barrett's metaplasia was dysplastic in 36 of the 38 esophageal tumors, 10 of the 13 cardiac tumors, but not in the subcardiac tumor. Conclusions: Adenocarcinomas located at the gastro-esophageal junction were associated with Barrett's metaplasia in nearly one half of the patients. The length of the Barrett segment tends to be short and may be missed during endoscopy. The presence of high-grade dysplasia within Barrett's mucosa supports a Barrett's origin for half of the adenocarcinomas arising at this location.

Original languageEnglish (US)
Pages (from-to)609-614
Number of pages6
JournalArchives of Surgery
Volume129
Issue number6
StatePublished - 1994
Externally publishedYes

Fingerprint

Cardia
Barrett Esophagus
Adenocarcinoma
Heart Neoplasms
Metaplasia
Neoplasms
Esophageal Diseases
Esophagogastric Junction
Endoscopy
Stomach
Mucous Membrane
Biopsy

ASJC Scopus subject areas

  • Surgery

Cite this

Clark, G. W. B., Smyrk, T. C., Burdiles, P., Hoeft, S. F., Peters, J. H., Kiyabu, M., ... DeMeester, T. R. (1994). Is Barrett's metaplasia the source of adenocarcinomas of the cardia? Archives of Surgery, 129(6), 609-614.

Is Barrett's metaplasia the source of adenocarcinomas of the cardia? / Clark, G. W B; Smyrk, Thomas Christopher; Burdiles, P.; Hoeft, S. F.; Peters, J. H.; Kiyabu, M.; Hinder, R. A.; Bremner, C. G.; DeMeester, T. R.

In: Archives of Surgery, Vol. 129, No. 6, 1994, p. 609-614.

Research output: Contribution to journalArticle

Clark, GWB, Smyrk, TC, Burdiles, P, Hoeft, SF, Peters, JH, Kiyabu, M, Hinder, RA, Bremner, CG & DeMeester, TR 1994, 'Is Barrett's metaplasia the source of adenocarcinomas of the cardia?', Archives of Surgery, vol. 129, no. 6, pp. 609-614.
Clark GWB, Smyrk TC, Burdiles P, Hoeft SF, Peters JH, Kiyabu M et al. Is Barrett's metaplasia the source of adenocarcinomas of the cardia? Archives of Surgery. 1994;129(6):609-614.
Clark, G. W B ; Smyrk, Thomas Christopher ; Burdiles, P. ; Hoeft, S. F. ; Peters, J. H. ; Kiyabu, M. ; Hinder, R. A. ; Bremner, C. G. ; DeMeester, T. R. / Is Barrett's metaplasia the source of adenocarcinomas of the cardia?. In: Archives of Surgery. 1994 ; Vol. 129, No. 6. pp. 609-614.
@article{9604a21bba9841fe85a543d2f6758f1b,
title = "Is Barrett's metaplasia the source of adenocarcinomas of the cardia?",
abstract = "Objective: To investigate the prevalence of Barrett's esophagus in patients with adenocarcinomas located at the gastroesophageal junction. Design: A case series of patients who underwent esophagogastrectomy for adenocarcinoma was retrospectively reviewed. Tumors were grouped by location as esophageal, cardiac, and subcardiac, and the prevalence of specialized intestinal metaplasia in the histological specimens was determined. Setting: A university department of surgery that specializes in esophageal diseases. Patients: One hundred patients with adenocarcinoma of the esophagus, cardia, or proximal stomach. Main Outcome: Cardiac adenocarcinomas were associated with Barrett's esophagus in 42{\%} of the patients. Results: Specialized intestinal metaplasia was identified in the histological sections from the resected specimen in 42{\%} (13/31) of cardiac adenocarcinomas and in 79{\%} (38/48) of esophageal adenocarcinomas but in only 5{\%} (1/21) of subcardiac adenocarcinomas. The preoperative endoscopic biopsy results concurred with the final diagnosis of Barrett's esophagus in 33 of the 38 esophageal tumors, six of the 13 cardiac tumors, and the one subcardiac tumor but failed to detect specialized intestinal metaplasia in 54{\%} (7/13) of cardiac tumors. Cardiac tumors were associated with shorter lengths of Barrett's mucosa than esophageal tumors (2.7 ± 1.8 cm vs 7.4 ± 3.4 cm, P<.01). The Barrett's metaplasia was dysplastic in 36 of the 38 esophageal tumors, 10 of the 13 cardiac tumors, but not in the subcardiac tumor. Conclusions: Adenocarcinomas located at the gastro-esophageal junction were associated with Barrett's metaplasia in nearly one half of the patients. The length of the Barrett segment tends to be short and may be missed during endoscopy. The presence of high-grade dysplasia within Barrett's mucosa supports a Barrett's origin for half of the adenocarcinomas arising at this location.",
author = "Clark, {G. W B} and Smyrk, {Thomas Christopher} and P. Burdiles and Hoeft, {S. F.} and Peters, {J. H.} and M. Kiyabu and Hinder, {R. A.} and Bremner, {C. G.} and DeMeester, {T. R.}",
year = "1994",
language = "English (US)",
volume = "129",
pages = "609--614",
journal = "JAMA Surgery",
issn = "2168-6254",
publisher = "American Medical Association",
number = "6",

}

TY - JOUR

T1 - Is Barrett's metaplasia the source of adenocarcinomas of the cardia?

AU - Clark, G. W B

AU - Smyrk, Thomas Christopher

AU - Burdiles, P.

AU - Hoeft, S. F.

AU - Peters, J. H.

AU - Kiyabu, M.

AU - Hinder, R. A.

AU - Bremner, C. G.

AU - DeMeester, T. R.

PY - 1994

Y1 - 1994

N2 - Objective: To investigate the prevalence of Barrett's esophagus in patients with adenocarcinomas located at the gastroesophageal junction. Design: A case series of patients who underwent esophagogastrectomy for adenocarcinoma was retrospectively reviewed. Tumors were grouped by location as esophageal, cardiac, and subcardiac, and the prevalence of specialized intestinal metaplasia in the histological specimens was determined. Setting: A university department of surgery that specializes in esophageal diseases. Patients: One hundred patients with adenocarcinoma of the esophagus, cardia, or proximal stomach. Main Outcome: Cardiac adenocarcinomas were associated with Barrett's esophagus in 42% of the patients. Results: Specialized intestinal metaplasia was identified in the histological sections from the resected specimen in 42% (13/31) of cardiac adenocarcinomas and in 79% (38/48) of esophageal adenocarcinomas but in only 5% (1/21) of subcardiac adenocarcinomas. The preoperative endoscopic biopsy results concurred with the final diagnosis of Barrett's esophagus in 33 of the 38 esophageal tumors, six of the 13 cardiac tumors, and the one subcardiac tumor but failed to detect specialized intestinal metaplasia in 54% (7/13) of cardiac tumors. Cardiac tumors were associated with shorter lengths of Barrett's mucosa than esophageal tumors (2.7 ± 1.8 cm vs 7.4 ± 3.4 cm, P<.01). The Barrett's metaplasia was dysplastic in 36 of the 38 esophageal tumors, 10 of the 13 cardiac tumors, but not in the subcardiac tumor. Conclusions: Adenocarcinomas located at the gastro-esophageal junction were associated with Barrett's metaplasia in nearly one half of the patients. The length of the Barrett segment tends to be short and may be missed during endoscopy. The presence of high-grade dysplasia within Barrett's mucosa supports a Barrett's origin for half of the adenocarcinomas arising at this location.

AB - Objective: To investigate the prevalence of Barrett's esophagus in patients with adenocarcinomas located at the gastroesophageal junction. Design: A case series of patients who underwent esophagogastrectomy for adenocarcinoma was retrospectively reviewed. Tumors were grouped by location as esophageal, cardiac, and subcardiac, and the prevalence of specialized intestinal metaplasia in the histological specimens was determined. Setting: A university department of surgery that specializes in esophageal diseases. Patients: One hundred patients with adenocarcinoma of the esophagus, cardia, or proximal stomach. Main Outcome: Cardiac adenocarcinomas were associated with Barrett's esophagus in 42% of the patients. Results: Specialized intestinal metaplasia was identified in the histological sections from the resected specimen in 42% (13/31) of cardiac adenocarcinomas and in 79% (38/48) of esophageal adenocarcinomas but in only 5% (1/21) of subcardiac adenocarcinomas. The preoperative endoscopic biopsy results concurred with the final diagnosis of Barrett's esophagus in 33 of the 38 esophageal tumors, six of the 13 cardiac tumors, and the one subcardiac tumor but failed to detect specialized intestinal metaplasia in 54% (7/13) of cardiac tumors. Cardiac tumors were associated with shorter lengths of Barrett's mucosa than esophageal tumors (2.7 ± 1.8 cm vs 7.4 ± 3.4 cm, P<.01). The Barrett's metaplasia was dysplastic in 36 of the 38 esophageal tumors, 10 of the 13 cardiac tumors, but not in the subcardiac tumor. Conclusions: Adenocarcinomas located at the gastro-esophageal junction were associated with Barrett's metaplasia in nearly one half of the patients. The length of the Barrett segment tends to be short and may be missed during endoscopy. The presence of high-grade dysplasia within Barrett's mucosa supports a Barrett's origin for half of the adenocarcinomas arising at this location.

UR - http://www.scopus.com/inward/record.url?scp=0028365812&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028365812&partnerID=8YFLogxK

M3 - Article

C2 - 8204035

AN - SCOPUS:0028365812

VL - 129

SP - 609

EP - 614

JO - JAMA Surgery

JF - JAMA Surgery

SN - 2168-6254

IS - 6

ER -