Barrett’s Esophagus

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