ADENOCARCINOMA OF THE ESOPHAGOGASTRIC JUNCTION AND BARRETTS-ESOPHAGUS

Background & Aims: Barrett's esophagus is associated with adenocarcino ma of the esophagus. The aim of this study was to find the prevalence of Barrett's esophagus in patients with adenocarcinoma of the esophago gastric junction. Methods: Consecutive, freshly resected surgical esop hagogastrectomy specimens were examined, and multiple histological sec tions were made around the tumor periphery. Barrett's esophagus was de fined as specialized columnar epithelium above the esophagogastric jun ction. Tumors centered less than or equal to 2 cm from the junction we re defined as junction cancers. Results: Barrett's esophagus was found in 9 of 9 (100%) esophageal adenocarcinomas compared with 0 of 8 (0%) squamous carcinoma controls (P < 0.001). Ten of 24 (42%) junction ade nocarcinomas had a Barrett's esophagus. A Barrett's esophagus was foun d in 8 of 12 (67%) junction cancers less than or equal to 6 cm in leng th but only 2 of 12 (17%) larger tumors (P < 0.05). Barrett's esophagu s was significantly associated with junction tumors; <6 cm compared wi th squamous carcinoma controls (P < 0.02). In 5 specimens with junctio n cancer, the length of Barrett's esophagus was <3 cm, and in 5 specim ens it was greater than or equal to 3 cm. Specialized epithelium was o ften found below the esophagogastric junction in controls. Conclusions : Adenocarcinomas of the esophagogastric junction are associated with short and long segments of Barrett's esophagus. Larger cancers probabl y overgrow and conceal the underlying specialized columnar epithelium from which they arise.