Posts Tagged ‘Add new tag’

How Large Are Biopsies versus Endoscopic Mucosal Resections?

Friday, May 22nd, 2009

This image, taken from my cell phone, shows glass microscope slides from two separate patients.  You can see the tissue (it has been stained) as the red and purple things on the glass slides.  On the left are small biopsies that Dr. Dunbar took from a patient in surveillance.  There are lots of spots because the tissue was cut into lots of tiny slices to put under the microscope to learn if the patient has dysplasia.  You can see by comparing the small biopsies on the left to the pencil that such biopsies are quite tiny (and therefor it is perfectly safe for you to have lots of biopsies).  In fact, the small spots actually consist of three separate biopsies so each is only about a millimeter! The endoscopic mucosal resection (EMR) on the right is much larger, but still a pretty small amount of tissue.  You can see from these samples that if you have an endoscopic procedure, the tissues removed from you are small fragments compared to what is removed during major surgery.

E. Montgomery, MD

Buried Barrett’s

Friday, April 3rd, 2009

On the top of the image there is a pink layer of squamous (normal) esophageal epithelium.  The glands (circular structures) below are dysplastic Barrett\'s mucosa.We have all been reading a lot about “buried Barrett’s” mucosa lately.  This image is at high magnification and shows a microscopic view of what a pathologist (a  specialized medical doctor who reviews biopsies under the microscope) sees in “buried Barrett’s”.  The top part of the image has a pink layer of normal squamous epithelium.  The glands underneath (the circular structures) are Barrett’s epithelium with dysplasia.  The concern among some is that an endoscopist might not see such areas since they are covered with normal lining epithelium.  This is more of a theoretical concern than a real problem since usually such areas are accompanied by areas that are easy for the endoscopist to see.  The other concern is that some types of treatments will fail to reach this buried layer.  There is a recent publication that shows that this is not a concern for patients treated with photodynamic therapy.  The reference for that study is below.  We are still learning the answer to this question for BARRx.

Bronner MP, Overholt BF, Taylor SL, Haggitt RC, Wang KK, Burdick JS, Lightdale CJ, Kimmey M, Nava HR, Sivak MV, Nishioka N, Barr H, Canto MI, Marcon N, Pedrosa M, Grace M, Depot M; International Photodynamic Therapy Group for High-Grade Dysplasia in Barrett’s Esophagus. Squamous overgrowth is not a safety concern for photodynamic therapy for Barrett’s esophagus with high-grade dysplasia. Gastroenterology. 2009 Jan;136(1):56-64