IS BARRETTS METAPLASIA THE SOURCE OF ADENOCARCINOMAS OF THE CARDIA

Objective: To investigate the prevalence of Barrett's esophagus in pat ients with adenocarcinomas located at the gastroesophageal junction. D esign: A case series of patients who underwent esophagogastrectomy for adenocarcinoma was retrospectively reviewed. Tumors were grouped by l ocation as esophageal, cardiac, and subcardiac, and the prevalence of specialized intestinal metaplasia in the histological specimens was de termined. Setting: A university department of surgery that specializes in esophageal diseases. Patients: One hundred patients with adenocarc inoma of the esophagus, cardia, or proximal stomach. Main Outcome: Car diac adenocarcinomas were associated with Barrett's esophagus in 42% o f the patients. Results: Specialized intestinal metaplasia was identif ied in the histological sections from the resected specimen in 42% (13 /31) of cardiac adenocarcinomas and in 79% (38/48) of esophageal adeno carcinomas but in only 5% (1/21) of subcardiac adenocarcinomas. The pr eoperative endoscopic biopsy results concurred with the final diagnosi s 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. Car diac tumors were associated with shorter lengths of Barrett's mucosa t han esophageal tumors (2.7+/-1.8 cm vs 7.4+/-3.4 cm, P<.01). The Barre tt's metaplasia was dys- plastic in 36 of the 38 esophageal tumors, 10 of the 13 cardiac tumors, but not in the subcardiac tumor. Conclusion s: Adenocarcinomas located at the gastroesophageal junction were assoc iated with Barrett's metaplasia in nearly one half of the patients. Th e length of the Barrett segment tends to be short and may be missed du ring endoscopy. The presence of high-grade dysplasia within Barrett's mucosa supports a Barrett's origin for half of the adenocarcinomas ari sing at this location.