Detection and staging of esophageal cancers within Barrett's esophagus is improved by assessment in specialized Barrett's units

Background: Identification and resection of mucosal abnormalities are critical in managing dysplastic Barrett's esophagus (BE) because these areas may harbor esophageal adenocarcinoma (EAC). Objectives: To compare mucosal lesion and EAC detection rates in dysplastic BE in the community versus a BE unit and assess the impact of EMR on disease staging and management. Design: Prospective cohort study. Setting: Tertiary referral center. Patients: Patients with dysplastic BE. Interventions: Reassessment with high-definition white-light endoscopy (HD-WLE), narrow-band imaging (NBI), and Seattle protocol biopsies. EMR performed in lesions thought to harbor neoplasia. Review of referral histology and endoscopies. Main Outcome Measurements: Mucosal lesion and EAC detection rates in a BE unit versus the community. Impact of EMR on management. Results: Sixty-nine patients were referred (88% male; median age, 69 years). At referral, HD-WLE/NBI usewas 57%/ 14%, and Seattle protocol adherence was 20%. Eighteen patients had intramucosal cancer. Lesions were detected in 65 patients in the BE unit versus 29 patients at referral (P <. 001). EMR was performed in 47 patients. BE unit assessment confirmed EAC in all 18 patients and identified 10 additional patients (56% increased cancer detection, P =. 036); all 10 had lesions identified in the BE unit (vs 3 identified at referral). EMR in these patients found submucosal cancer (n = 4) and intramucosal cancer (n = 6), resulting in esophagectomy (n = 4) and chemoradiotherapy (n = 1). Limitation: Academic center. Conclusion: BE assessment at a BE unit resulted in increased lesion and EAC detection. EMR of early cancers was critical in optimizing patient management. These data suggest that BE unit referral be considered in patients with dysplastic BE.