Location, location, location: does early cancer in Barrett’s esophagus have a preference?

• Published in: Gastrointestinal endoscopy 2013-09, Vol.78 (3), p.462-467
• Main Authors: Enestvedt, Brintha K., MD, MBA, Lugo, Ricardo, MD, Guarner-Argente, Carlos, MD, Shah, Pari, MD, MSc, Falk, Gary W., MD, Furth, Emma, MD, Ginsberg, Gregory G., MD
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - surgery; Aged; Barrett Esophagus - pathology; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagoscopy; Esophagus - pathology; Female; Gastroenterology and Hepatology; Humans; Male; Middle Aged; Mucous Membrane - pathology; Mucous Membrane - surgery; Neoplasm Invasiveness; Precancerous Conditions - pathology; Precancerous Conditions - surgery; Retrospective Studies
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2013.03.167

Background Early cancer (high-grade dysplasia [HGD] and intramucosal carcinoma [ImCa]) associated with Barrett’s esophagus (BE) may have a circumferential spatial predilection. Objective To describe the esophageal circumferential location of early cancer in BE. Design and Setting Retrospective study, single tertiary referral center. Patients and Intervention One hundred nineteen patients were referred for endoscopic eradication therapy for early cancer associated with BE. Endoscopic images and reports and pathology were reviewed. Main Outcome Measurements Circumferential location designation of early cancer in BE by using a clock-face orientation. Results One hundred nineteen of 131 patients referred for endoscopic eradication therapy had a location designation for their advanced histology (91.9%). There were a total of 57 patients (47.9%) with HGD and 62 patients (52.1%) with ImCa. There was a significantly higher rate of early cancer (HGD or ImCa) in the right hemisphere (12 to 6 o’clock location) compared with the left hemisphere (84.9% vs 15.1%, P  < .0001). The highest percentage of early cancer was found in the 12 to 3 o’clock quadrant (64.7%); 71.9% of HGD and 58.1% of ImCa lesions were located in the 12 to 3 o’clock quadrant. Limitations Retrospective design, single center. Conclusions Early cancer associated with BE is far more commonly found in the right hemisphere of the esophagus (12 to 6 o’clock) with the highest rate in the 12 to 3 o’clock quadrant. These findings support enhanced scrutiny of the right hemisphere of the esophagus during surveillance and endoscopic treatment of patients with BE.