| Theme |
Diagnosis and Treatment of Barrett's Esophagus : up-to-date |
| Title |
Differences between Barrett's Esophagus and Barrett's Esophageal Cancer in Japan and Western Countries |
| Author |
Tomoyuki Koike |
Division of Gastroenterology, Tohoku University Graduate School of Medicine |
| Author |
Kenichiro Nakagawa |
Division of Gastroenterology, Tohoku University Graduate School of Medicine |
| Author |
Masahiro Saito |
Division of Gastroenterology, Tohoku University Graduate School of Medicine |
| Author |
Hirohiko Shinkai |
Division of Gastroenterology, Tohoku University Graduate School of Medicine |
| Author |
Katsunori Iijima |
Division of Gastroenterology, Tohoku University Graduate School of Medicine |
| Author |
Tooru Shimosegawa |
Division of Gastroenterology, Tohoku University Graduate School of Medicine |
| [ Summary ] |
According to the definition used in Western countries, the presence of goblet cells is the most significant feature in diagnosing Barrett's esophagus (BE). BE is defined as the metaplastic replacement of any length of the esophageal epithelium that can be recognized during endoscopy and confirmed by biopsy of the tubular esophagus which contains specialized columnar epithelium. In Japan, on the other hand, the gastro-esophageal junction is usually defined endoscopically as "the lower limit of palisade longitudinal vessels". Therefore, when palisade vessels are visible through metaplastic columnar epithelium, a diagnosis of Barrett's mucosa can be made by endoscopic examination alone, without histological examination. Japanese pathologists need not diagnose high-grade dysplasia (HGD) (which is diagnosed as well-differentiated adenocarcinoma) in BE lesions. After focal endoscopic resection of BE cancer or HGD, the remaining BE may be effectively treated with radiofrequency ablation (RFA). RFA has become a widely employed ablative method in Western countries. On the other hand, in Japan, there have been few case reports concerning complete eradication of BE, because the risk of developing synchronous or metachronous lesions is very low in Japan. Most Japanese experts recommend endoscopic submucosal dissection (ESD) for BE cancer. |