Barrett's oesophagus and associated dysplasia are not equally distributed within the esophageal circumference

BackgroundA careful endoscopic surveillance of Barrett's oesophagus is warranted to prevent esophageal cancer.AimTo identify the preferred location of non-circumferential Barrett's oesophagus and associated dysplasia within the esophageal circumference.MethodsWe retrospectively reviewed a prospectively maintained database of patients with non-circumferential lesions. The location of metaplastic lesions and dysplastic lesions within the esophageal circumference was identified as on a clock face, and their distribution in the 4 quadrants was compared.ResultsOf overall 443 patients with Barrett's oesophagus, 192 (43%) were eligible for our study. Multiple lesions were diagnosed in 110 (57%) of them, for a total amount of 352 metaplastic areas. Barrett's oesophagus lesions were located significantly more in the posterior wall of the oesophagus (38.4%), rather than in the right wall (28.8%), the anterior wall (22.6%), or the left wall (10.2%) (P < 0.0001). Among all metaplastic lesions, 28 were associated with dysplasia (7.9%), and one with adenocarcinoma (0.3%). Dysplastic lesions were significantly more common in the posterior wall (39.3%) than, respectively, in the anterior wall (35.8%), the right wall (21.4%) or the left wall (3.5%) (P = 0.03).ConclusionOur results show that the posterior wall of the oesophagus is the preferential location of both Barrett's oesophagus and associated dysplasia.