Diagnosis of Barrett’s Oesophagus

Barrett’s oesophagus (Columnar lined oesophagus)-Normal squamous lining has been replaced by a metaplastic columnar epithelium which is visible macroscopically. In order to make a positive diagnosis of “Barrett’s oesophagus”, a segment of columnar metaplasia of any length must be visible endoscopically above the oesophago-gastric junction and confirmed or corroborated histologically.

  • Diagnostic of CLO – Native oesophageal structures with metaplastic glandular mucosa, +/-intestinal metaplasia.

  • Biopsies corroborative of an endoscopic diagnosis of CLO – Intestinalised metaplastic glandular mucosa with no evidence of native oesophageal structures. This could potentially still represent incomplete intestinal metaplasia in the stomach, especially in a hiatus hernia or IM at the cardia.
  • Biopsies in keeping with, but not specific for CLO- Gastric type mucosa of either fundic or cardic type without IM. Patchwork appearance is still possible, as is a non-organised arrangement. Such appearances could, however, represent the OG junction or the stomach, with or without hiatal hernia.
  • Biopsies without evidence of CLO – Oesophageal type squamous mucosa with no evidence of glandular epithelium.

References:

British Society of Gastroenterology. Guidelines for the diagnosis and management of columnar lined Barrett’s oesophagus.

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