Directional distribution of neoplasia in Barrett's esophagus is not influenced by distance from the gastroesophageal junction

BackgroundAccurate endoscopic detection and staging are critical for appropriate management of Barrett's esophagus (BE)–associated neoplasia. Prior investigation has demonstrated that the distribution of endoscopically detectable early neoplasia is not uniform but instead favors specific directional distributions within a short BE segment; however, it is unknown whether the directional distribution of neoplasia differs with increasing distance from the gastroesophageal junction, including in patients with long-segment BE.ObjectiveTo identify whether directional distribution of BE-associated neoplasia is influenced by distance from the gastroesophageal junction.DesignRetrospective cohort study.SettingTertiary-care referral center.PatientsPatients with either short-segment or long-segment BE undergoing EMR.InterventionEMR.Main Outcome MeasurementsDirectional distribution of BE-associated neoplasia stratified by distance from gastroesophageal junction.ResultsEMR was performed on 60 lesions meeting study criteria during the specified time period. Pathology demonstrated low-grade dysplasia in 22% (13/60), high-grade dysplasia in 38% (23/60), intramucosal (T1a) adenocarcinoma in 23% (14/60), and invasive (≥T1b) adenocarcinoma in 17% (10/60). Directional distribution of lesions was not uniform (P < .001), with 62% of lesions (37/60) located between the 1 o'clock and 5 o'clock positions. When circular statistics methodology was used, there was no difference in the directional distribution of neoplastic lesions located within 3 cm of the gastroesophageal junction compared with ≥3 cm from the gastroesophageal junction.LimitationsSingle-center study may limit external validity.ConclusionThe directional distribution of neoplastic foci within a BE segment is not influenced by distance of the lesion from the gastroesophageal junction. Mucosa between the 1 o'clock and 5 o'clock locations merits careful attention and endoscopic inspection in individuals with both short-segment BE and long-segment BE.