This review focuses on the histopathological evaluation of
endoscopic mucosal resection (EMR) specimens in Barrett’s esophagus, and
on the histopathological, biological, and molecular properties of postablation
Barrett’s esophagus. EMR may be used for both diagnostic and therapeutic
purposes. Diagnostic accuracy regarding the grade and stage of neoplasms is
improved with the use of EMR, but the value of this technique for treatment is
more controversial because of the high prevalence rate of positive margins and
the rate of metachronous lesions found elsewhere in the esophagus during
follow-up. Ablation techniques, such as argon plasma coagulation, photodynamic
therapy, and radiofrequency ablation, are used increasingly for the treatment
of Barrett’s esophagus and related neoplasms, often in combination with
EMR. A common problem after use of these techniques is the development of
islands of neosquamous epithelium (NSE) which can overlie buried
Barrett’s (and/or dysplasia) epithelium. This is, therefore, concealed to
the endoscopist’s view and may be allowed to progress to cancer without
detection. NSE is histologically similar to normal esophageal squamous
epithelium and does not possess the molecular aberrations characteristic of
Barrett’s esophagus. In contrast, residual nonburied Barrett’s
esophagus shows persistent pathologic and molecular abnormalities and may
progress to cancer upon long term follow-up. The biological potential and rate
of progression of nonburied residual Barrett’s esophagus following
ablation is unclear, but some preliminary studies suggest that the risk may
decrease. Buried nondysplastic Barrett’s esophagus appears to show
decreased biological potential and this may be related to protection from the
contents of the lumen by the barrier function of the overlying NSE. On the
other hand, anecdotal reports have suggested that buried dysplasia may progress
to cancer in some instances.
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