Barrett Esophagus Workup

Updated: Dec 29, 2017
  • Author: Mark H Johnston, MD; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Workup

Approach Considerations

The association of chronic GERD with Barrett esophagus and the inherent risk of progression from Barrett esophagus to adenocarcinoma of the esophagus have been established. Consequently, any patient aged 50 years or older, male or female, with a history of chronic GERD should have at least a 1-time upper endoscopy to screen for Barrett esophagus.

Esophagogastroduodenoscopy

Esophagogastroduodenoscopy (EGD) is the procedure of choice for the diagnosis of Barrett esophagus. The diagnosis requires biopsy confirmation of SIM in the esophagus. An upper gastrointestinal series (UGI) or barium swallow cannot reliably establish the diagnosis of Barrett esophagus.

In cases of erosive esophagitis, a healing of the mucosa is required prior to EGD to ensure a lack of Barrett mucosa underneath the inflammation.

Histologic findings

The presence of SIM in the esophagus is required for the diagnosis of Barrett esophagus.

Ultrasonography

When high-grade dysplasia or cancer is found on surveillance endoscopy, endoscopic ultrasonography (EUS) is advisable to evaluate for surgical resectability.

Fluorescence in situ hybridization

A commercial four-color fluorescence in-situ hybridization (FISH) probe set to 9p12 (CDKN2A), 17q11.2-12 (HER2), 8q24.12-13 (CMYC), and 20q13.2 (ZNF217) appears to be able to detect aneusomy in Barrett esophagus. [12] In a study consisting of 20 cases of Barrett esophagus, significant increases inHER2, CMYC, and ZNF217 copy number were found in dysplastic mucosa compared with nondysplastic mucosa. However, non-detection of aneusomy did not rule out dysplasia. [12]