This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Geoffrey W. B. Clark, FRCS(Ed); Thomas C. Smyrk, MD; Patricio Burdiles, MD; Sebastian F. Hoeft, MD; Jeffrey H. Peters, MD; Milton Kiyabu, MD; Ronald A. Hinder, MD, PhD; Cedric G. Bremner, MD; Tom R. DeMeester, MD

Arch Surg. 1994;129(6):609-614.

Abstract
Objective
To investigate the prevalence of Barrett's esophagus in patients with adenocarcinomas located at the gastroesophageal junction.

Design
A case series of patients who underwent esophagogastrectomy for adenocarcinoma was retrospectively reviewed. Tumors were grouped by location as esophageal, cardiac, and subcardiac, and the prevalence of specialized intestinal metaplasia in the histological specimens was determined.

Setting
A university department of surgery that specializes in esophageal diseases.

Patients
One hundred patients with adenocarcinoma of the esophagus, cardia, or proximal stomach.

Main Outcome
Cardiac adenocarcinomas were associated with Barrett's esophagus in 42% of the patients.

Results
Specialized intestinal metaplasia was identified in the histological sections from the resected specimen in 42% (13/31) of cardiac adenocarcinomas and in 79% (38/48) of esophageal adenocarcinomas but in only 5% (1/21) of subcardiac adenocarcinomas. The preoperative endoscopic biopsy results concurred with the final diagnosis of Barrett's esophagus in 33 of the 38 esophageal tumors, six of the 13 cardiac tumors, and the one subcardiac tumor but failed to detect specialized intestinal metaplasia in 54% (7/13) of cardiac tumors. Cardiac tumors were associated with shorter lengths of Barrett's mucosa than esophageal tumors (2.7±1.8 cm vs 7.4±3.4 cm, P<.01). The Barrett's metaplasia was dysplastic in 36 of the 38 esophageal tumors, 10 of the 13 cardiac tumors, but not in the subcardiac tumor.

Conclusions
Adenocarcinomas located at the gastroesophageal junction were associated with Barrett's metaplasia in nearly one half of the patients. The length of the Barrett segment tends to be short and may be missed during endoscopy. The presence of high-grade dysplasia within Barrett's mucosa supports a Barrett's origin for half of the adenocarcinomas arising at this location.

(Arch Surg. 1994;129:609-614)

Author Affiliations
From the Departments of Surgery (Drs Clark, Burdiles, Hoeft, Peters, Bremner, and DeMeester) and Pathology (Dr Kiyabu), University of Southern California School of Medicine, Los Angeles; the Department of Pathology, Clarkson Memorial Hospital, Omaha, Neb (Dr Smyrk); and the Department of Surgery, Creighton University, Omaha (Dr Hinder).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Prognostic Factors in Adenocarcinoma of the Esophagus or Gastroesophageal Junction
Lagarde et al.
JCO 2006;24:4347-4355.
ABSTRACT | FULL TEXT  

Familiality in Barrett's Esophagus, Adenocarcinoma of the Esophagus, and Adenocarcinoma of the Gastroesophageal Junction.
Chak et al.
Cancer Epidemiol. Biomarkers Prev. 2006;15:1668-1673.
ABSTRACT | FULL TEXT  

Familial aggregation of Barrett's oesophagus, oesophageal adenocarcinoma, and oesophagogastric junctional adenocarcinoma in Caucasian adults
Chak et al.
Gut 2002;51:323-328.
ABSTRACT | FULL TEXT  

Relative risk of dysplasia for patients with intestinal metaplasia in the distal oesophagus and in the gastric cardia
Sharma et al.
Gut 2000;46:9-13.
ABSTRACT | FULL TEXT  

Evaluating Gastric Cancer Misclassification: a Potential Explanation for the Rise in Cardia Cancer Incidence
Ekstrom et al.
JNCI J Natl Cancer Inst 1999;91:786-790.
ABSTRACT | FULL TEXT  

Symptomatic Gastroesophageal Reflux as a Risk Factor for Esophageal Adenocarcinoma
Lagergren et al.
NEJM 1999;340:825-831.
ABSTRACT | FULL TEXT  

Adenocarcinoma of the Esophagus and Gastric Cardia: Is There Progress in the Face of Increasing Cancer Incidence?
Sampliner
ANN INTERN MED 1999;130:67-69.
FULL TEXT  

Esophageal surgery at the end of the millennium
Lerut
J. Thorac. Cardiovasc. Surg. 1998;116:1-20.
FULL TEXT  

Intestinal metaplasia at the gastro-oesophageal junction: Helicobacter pylori gastritis or gastro-oesophageal reflux disease?
Hackelsberger et al.
Gut 1998;43:17-21.
ABSTRACT | FULL TEXT  

Short segments of Barrett's epithelium and intestinal metaplasia in normal appearing oesophagogastric junctions: the same or two different entities?
Pereira et al.
Gut 1998;42:659-662.
ABSTRACT | FULL TEXT  

Proposed Revision Of The Staging Classification For Esophageal Cancer
Korst et al.
J. Thorac. Cardiovasc. Surg. 1998;115:660-670.
ABSTRACT | FULL TEXT  

The aging oesophagus
TACK and VANTRAPPEN
Gut 1997;41:422-424.
FULL TEXT  

Ten years' experience of screening patients with Barrett's oesophagus in a university teaching hospital
Macdonald et al.
Gut 1997;41:303-307.
ABSTRACT | FULL TEXT  

ESOPHAGOGASTRECTOMY FOR CARCINOMA OF THE ESOPHAGUS AND CARDIA: A COMPARISON OF FINDINGS AND RESULTS AFTER STANDARD RESECTION IN THREE CONSECUTIVE EIGHT-YEAR INTERVALS WITH IMPROVED STAGING CRITERIA
Ellis et al.
J. Thorac. Cardiovasc. Surg. 1997;113:836-848.
ABSTRACT | FULL TEXT  

Detection of Barrett's Adenocarcinoma of the Gastric Cardia With Sucrase Isomaltase and p53
Iannettoni et al.
Ann. Thorac. Surg. 1996;62:1460-1465.
ABSTRACT | FULL TEXT  

Gastroesophageal Reflux Disease
Kahrilas
JAMA 1996;276:983-988.
ABSTRACT  

Adenocarcinoma in the Distal Esophagus With and Without Barrett Esophagus: Differences in Symptoms and Survival Rates
Johansson et al.
Arch Surg 1996;131:708-713.
ABSTRACT  

Invited Commentary
Bremner
Arch Surg 1996;131:713-713.
ABSTRACT  

TUMORS OF THE ESOPHAGOGASTRIC JUNCTIONLong-term survival in relation to the pattern of lymph node metastasis and a critical analysis of the accuracy or inaccuracy of pTNM classification
Steup et al.
J. Thorac. Cardiovasc. Surg. 1996;111:85-95.
ABSTRACT | FULL TEXT