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Barrett's esophagus: Pathogenesis, epidemiology, functional abnormalities, malignant degeneration, and surgical management

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Abstract

Barrett's esophagus (i.e. columnar epithelial metaplasia in the distal esophagus) is an acquired condition that in most patients results from chronic gastroesophageal reflux. It is a disorder of the white male in the Western world with a prevalence of about 1/400 population. Due to the decreased sensitivity of the columnar epithelium to symptoms, Barrett's esophagus remains undiagnosed in the majority of patients. Gastroesophageal reflux disease in patients with Barrett's esophagus has a more severe character and is more frequently associated with complications as compared with reflux patients without columnar mucosa. This appears to be due to a combination of a mechanically defective lower esophageal sphincter, inefficient esophageal clearance function, and gastric acid hypersecretion. Excessive reflux of alkaline duodenal contents may be responsible for the development of complications (i.e., stricture, ulcer, and dysplasia). Therapy of benign Barrett's esophagus is directed towards treatment of the underlying reflux disease. Barrett's esophagus is associated with a 30- to 125-fold increased risk for adenocarcinoma of the esophagus. The reasons for the dramatic rise in the incidence of esophageal adenocarcinoma, which occurred during the past years, are unknown. High grade dysplasia in a patient with columnar mucosa is an ominous sign for malignant degeneration. Whether an esophagectomy should be performed in patients with high grade dysplasia remains controversial. Complete resection of the tumor and its lymphatic drainage is the procedure of choice in all patients with a resectable carcinoma who are fit for surgery. In patients with tumors located in the distal esophagus, this can be achieved by a transhiatal en-bloc esophagectomy and proximal gastrectomy. Early adenocarcinoma can be cured by this approach. The value of multimodality therapy in patients with advanced tumors needs to be shown in randomized prospective trials.

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References

  1. Barrett NR: Chronic peptic ulcer of the esophagus and esophagitis.Br J Surg 38:175–182, 1950

    Google Scholar 

  2. Allison PR, Johnstone AS: The esophagus lined with gastric mucous membrane.Thorax 8:87–101, 1953

    Google Scholar 

  3. Barrett NR: The lower esophagus lined by columnar epithelium.Surgery 41:881–894, 1957

    Google Scholar 

  4. Lortat-Jacob JL: L'endobrachy-ösophage.Ann Chir 11:1247–1252, 1957

    Google Scholar 

  5. Giuli R: The story of modern disease-N. Barrett, JL LortatJacob.Dis Esoph 5:5–12, 1992

    Google Scholar 

  6. Johns BAE: Development changes in the esophageal epithelium in man.J Anat 86:431–442, 1952

    Google Scholar 

  7. Goldman MC, Beckman RC: Barrett syndrome: case report with discussion about concepts of pathogenesis.Gastroenterology 39:104–110, 1960

    Google Scholar 

  8. Hayward J: The treatment of fibrous stricture of the esophagus associated with hiatal hernia.Thorax 16:45–55, 1961

    Google Scholar 

  9. Adler RH: The lower esophagus lined by columnar epithelium: its association with hiatal hernia, ulcer, stricture and tumor.J Thorac Cardiovasc Surg 45:13, 1963

    Google Scholar 

  10. Bremner CG, Lynch VP, Ellis FH: Barrett's esophagus: congenital or acquired? An experimental study of esophageal mucosal regeneration in the dog.Surgery 68:209–216, 1978

    Google Scholar 

  11. Skinner DB, Walter BC, Riddel RH, Schmidt H, lascone C, DeMeester TR: Barrett's esophagus: comparison of benign and malignant cases.Ann Surg 198:554–566, 1983

    Google Scholar 

  12. Rector LE, Connerley ML: Aberrant mucosa in the esophagus in infants and children.Arch Pathol Lab Med 31:285–294, 1941

    Google Scholar 

  13. Borhan-Manesh F, Farnum JB: Incidence of heterotopic gastric mucosa in the upper oesophagus.Gut 32:968–972, 1991

    Google Scholar 

  14. Iascone C, DeMeester TR, Little AG, Skinner DB: Barrett's esophagus: functional assessment, proposed pathogenesis, and surgical therapy.Arch Surg 118:543–549, 1983

    Google Scholar 

  15. Hennessy TPJ: Barrett's esophagus.Br J Surg 72:336–340, 1985

    Google Scholar 

  16. Borrie J, Goldwater L: Columnar cell-lined esophagus. Assessment of etiology and treatment.J Thorac Cardiovasc Surg 71:825–834, 1976

    Google Scholar 

  17. Gillen P, Keeling P, Byrne PJ, Hennessy TPJ: Experimental columnar metaplasia in the canine oesophagus.Br J Surg 75:113–115, 1988

    Google Scholar 

  18. Hamilton SR, Yardly JH: Regeneration of cardiac type mucosa and acquisition of Barrett mucosa after esophagogastrectomy.Gastroenterology 72:669–675, 1977

    Google Scholar 

  19. Meyer W, Vollmar F, Bar W: Barrett's esophagus following total gastrectomy. A contribution to its pathogenesis.Endoscopy 2:121–126, 1979

    Google Scholar 

  20. Sartori S, Nielsen J, Indelli M, et al: Barrett's esophagus after chemotherapy with cyclophosphamide, methotrexate, and 5-fluouracil: an iatrogenic injury?Ann Intern Med 114:210–221, 1991

    Google Scholar 

  21. Barrett Dahms B, Greco MA, Stradjord SE, Rothsteir FC: Barrett's esophagus in three children after antileucemia chemotherapy.Cancer 60:2896–2900, 1987

    Google Scholar 

  22. Gelfand MD: Barrett's esophagus in sexagenarian identical twins.J Clin Gastroenterol 5:251–253, 1983

    Google Scholar 

  23. Jochem VJ, Fuerst PA, Fromkes JJ: Familial Barrett's esophagus associated with adenocarcinoma.Gastroenterology 102:1400–1402, 1992

    Google Scholar 

  24. Evarhart CW, Holtwapple DG, Humphries TJ: Barrett's esophagus: inherited epithelium or inherited reflux?J Clin Gastroenterol 5:357–360, 1983

    Google Scholar 

  25. Trier JS: Morphology of the epithelium of the distal esophagus in patients with midesophageal peptic stricture.Gastroenterology 58:444–461, 1970

    Google Scholar 

  26. Paull A, Trier JS, Dalton MD, et al: The histologic spectrum of Barrett's esophagus.N Engl J Med 295:476–480, 1976

    Google Scholar 

  27. Wesdorp ICE, Bartelsman J, Schipper MEI, Offerhaus J, Tytgat GNJ: Malignancy and premalignancy in Barrett's esophagus: a clinical, endoscopic, and histological study of 100 patients.Acta Endoscopy 11:317–326, 1981

    Google Scholar 

  28. Craemer B, Shorter RG, Bamforth J: The turnover and shedding of epithelial cells.Gut 2:110–118, 1961

    Google Scholar 

  29. Spechler SJ, Goyal RK: Barrett's esophagus.N Engl J Med 315:362–371, 1986

    Google Scholar 

  30. Cameron AJ, Lomboy CT: Barrett's esophagus: age, prevalence, and extent of columnar epithelium.Gastroenterology 103:1241–1245, 1992

    Google Scholar 

  31. Gruppo Operativo Per Le Studio Delle Precancerosi Dell'Esophago (GOSPE): Barrett's esophagus: epidemiological and clinical results of a multicentric survey.Int J Cancer 48:364–368, 1991

    Google Scholar 

  32. Sarr MG, Hamilton FR, Marone GC, Cameron JL: Barrett's esophagus: its prevalence and association with symptoms of gastroesophageal reflux.Am J Surg 149:187–193, 1985

    Google Scholar 

  33. Savary M, Miller G: Frequency and importance of endobrachyesophagus in reflux disease. In: Siewert JR, Hölscher AH (eds.): Diseases of the Esophagus. Berlin, Springer-Verlag, 1988, pp 552–532

    Google Scholar 

  34. Winters C, Spurling TJ, Chobanian SJ, et al: Barrett's esophagus: a prevalent, occult complication of gastroesophageal reflux disease.Gastroenterology 92:118–124, 1987

    Google Scholar 

  35. Rothery GA, Patterson JE, Stoddard CJ, Day DW: Histological and histochemical changes in columnar-lined (Barrett's) esophagus.Gut 27:1062–1068, 1986

    Google Scholar 

  36. Burbige EJ, Radigan JI: Characteristics of the columnar-celllined (Barrett's) esophagus.Gastrointest Endosc 25:133–136, 1979

    Google Scholar 

  37. Stein HJ, Barlow AP, DeMeester TR, Hinder RA: Complications in gastroesophageal reflux disease. Role of the lower esophageal sphincter, duodenogastric reflux and esophageal acid and alkaline exposure.Ann Surg 216:35–43, 1992

    Google Scholar 

  38. DeMeester TR, Stein HJ: Gastroesophageal reflux disease. In: Moody FG, Jones RS, Kelly KA, Nahrwold DL, Skinner DB (eds.): Surgical Treatment of Digestive Disease, 2nd ed Chicago: Year Book Medical Publishers, 1989, pp 65–108

    Google Scholar 

  39. Cameron AJ, Zinsmeister AR, Ballard DJ, Carney AJ: Prevalence of columnar-lined (Barrett's) esophagus: comparison of population-based clinical and autopsy findings.Gastroenterology 99:918–922, 1990

    Google Scholar 

  40. Gillen P, Keeling P, Byrne PJ, Hennessy TPJ: Barrett's esophagus: pH profile.Br J Surg 74:774–776, 1987

    Google Scholar 

  41. Stein HJ, Hoeft S, DeMeester TR: Reflux and motility pattern in Barrett's esophagus.Dis Esoph 5:21–28, 1992

    Google Scholar 

  42. Stein HJ, DeMeester TR, Naspetti R, Jamieson J, Naspetti R, Perry R: The three-dimensional lower esophageal sphincter pressure profile in gastroesophageal reflux disease.Ann Surg 214:374–384, 1991

    Google Scholar 

  43. Rossiter A, Guelrud M, Souney PF, et al: High vasoactive intestinal polypeptide plasma levels in patients with Barrett's esophagus.Scand J Gastroenterol 26:572–576, 1991

    Google Scholar 

  44. Kahrilas PJ, Dodds WJ, Hogan WJ: Effect of peristaltic dysfunction on esophageal volume clearance.Gastroenterology 94:73–80, 1988

    Google Scholar 

  45. Stein HJ, Eypasch EP, DeMeester TR: Circadian esophageal motor function in patients with gastroesophageal reflux disease.Surgery 108:769–777, 1990

    Google Scholar 

  46. Orr WC, Lackey C, Robinson MG, et al: Esophageal acid clearance during sleep in patients with Barrett's esophagus.Dig Dis Sci 33:654–659, 1988

    Google Scholar 

  47. Feczko PJ, Ma CK, Halpert RD, Batra SK: Barrett's metaplasia and dysplasia in post-myotomy achalasia patients.Am J Gastroenterol 78:265–268, 1983

    Google Scholar 

  48. Agha FP, Jeren DF: Barrett's esophagus complicating achalasia after esophagomyotomy.J Clin Gastroenterol 9:232–237, 1987

    Google Scholar 

  49. Cameron AJ, Payne WS: Barrett's esophagus occurring as a complication of scleroderma.Mayo Clinic Proc 53:612–615, 1978

    Google Scholar 

  50. Katzka DA, Reynolds JC, Saul] SH, Plotkin A, Lang CA, Ouyang A, et al: Barrett's metaplasia and adenocarcinoma of the esophagus in scleroderma.Am J Med 82:46–52, 1987

    Google Scholar 

  51. Mulholland MW, Reid, Levine DS, Rubin CE: Elevated gastric acid secretion in patients with Barrett's metaplastic epithelium.Dig Dis Sci 34:1329–1335, 1989

    Google Scholar 

  52. Collen MJ, Johnson DA: Correlation between basal acid output and daily ranitidine dose required for therapy in Barrett's esophagus.Dig Dis Sci 37:570–576, 1992

    Google Scholar 

  53. Karl TR, Pindick F, Sicular A: Zollinger-Ellison syndrome with esophagitis and Barrett's mucosa.Am J Gastroenterol 78:611–614, 1983

    Google Scholar 

  54. Hirschowitz BI: A critical analysis, with appropriate controls, of gastric acid and pepsin secretion in clinical esophagitis.Gastroenterology 101:1149–1158, 1991

    Google Scholar 

  55. Attwood SEA, DeMeester TR, Bremner CB, Barlow AP, Hinder RA: Alkaline gastroesophageal reflux: implications in the development of complications in Barrett's columnar-lined lower esophagus.Surgery 106:764–770, 1989

    Google Scholar 

  56. Gillen P, Byrne PJ, Heally M, O'Moore RR, Henessy TPJ: Implication of duodenogastric reflux in the pathogenesis of Barrett's esophagus.Br J Surg 75:540–543, 1988

    Google Scholar 

  57. Waring JP, Legrand J, Chibichian A, Sanowski RA: Duodenogastric reflux in patients with Barrett's esophagus.Dig Dis Sci 35:759–762, 1990

    Google Scholar 

  58. Salzman M, Barwick K, McCallum RW: Progression of cimetidine-treated reflux esophagitis to a Barrett's stricture.Dig Dis Sci 27(2):181–183, 1982

    Google Scholar 

  59. Bremner CG: Barrett's oesophagus.Br J Surg 76:995–996, 1989

    Google Scholar 

  60. Lenspa SJ, Spechler SJ, DeMeester TR, et al: Incidence of esophageal stricture formation with complicated gastroesophageal reflux disease.Gastroenterology 100:A107, 1991

    Google Scholar 

  61. Spechler SJ, The Dept of Veterans Affairs Gastroesophageal Reflux Study Group: comparison of medical and surgical therapy for complicated gastroesophageal reflux disease in veterans.N Engl J Med 326:786–792, 1992

    Google Scholar 

  62. Attwood SEA, Barlow AP, Norris TL, Watson A: Barrett's oesophagus: effect of antireflux surgery on symptom control and development of complications.Br J Surg 79:1050–1053, 1992

    Google Scholar 

  63. Brand DL, Ylvisaker JT, Gelfand M, Pope CE: Regression of columnar esophageal (Barrett's) epithelium after antireflux surgery.N Engl J Med 302:844–848, 1980

    Google Scholar 

  64. DeViere J, Buset M, Dumonceau JM, Rickaert F, Cremer M: Regression of Barrett's epithelium with omeprazol.N Engl J Med 320:1497–1498, 1989

    Google Scholar 

  65. Fékété F, Pateron D: What is the place of antrectomy with Roux-en-Y in the treatment of reflux disease? Experience with 83 total duodenal diversions.World J Surg 16:349–354, 1992

    Google Scholar 

  66. Sampliner RE, Garewal HS, Fennerty MB, Aickin M: Lack of impact of therapy on extent of Barrett's esophagus in 67 patients.Dig Dis Sci 35:93–96, 1990

    Google Scholar 

  67. Skinner DB: Controversies about Barrett's esophagus.Ann Thor Surg 49:523–524, 1990

    Google Scholar 

  68. DeMeester TR, Attwood SEA, Smyrk TC, et al: Surgical therapy in Barrett's esophagus.Ann Surg 212:528–542, 1990

    Google Scholar 

  69. McCallum RW, Polepalle S, Davenport K, Boyd S: Role of antireflux surgery against dysplasia in Barrett's esophagus.Gastroenterology 100:A121, 1991

    Google Scholar 

  70. Stein HJ, Siewert JR: Surgical options for the treatment of Barrett's esophagus.Acta Endoscop 1992 (in press)

  71. Stein HJ, DeMeester TR: Who benefits from antireflux surgery?World J Surg 16:313–319, 1992

    Google Scholar 

  72. DeMeester TR, Bonavina L, Albertucci M: Nissen fundoplication for gastroesophageal reflux disease. Evaluation of primary repair in 100 consecutive patients.Ann Surg 204:9–20, 1986

    Google Scholar 

  73. Siewert JR, Feussner H, Walker SJ: Fundoplication: How to do it? Periesophageal wrapping as therapeutic principle in gastroesophageal reflux prevention.World J Surg 16:326–334, 1992

    Google Scholar 

  74. DeMeester TR, Stein HJ: Minimizing the side effects of antireflux surgery.World J Surg 16:335–336, 1992

    Google Scholar 

  75. Dellemagne B, Weerts JM, Jehaes C, Markiewicz S, Lombard R: Laparoscopic Nissen fundoplication: preliminary report.Surg Laparosc Endosc 1:138–143, 1991

    Google Scholar 

  76. Stein HJ, Feussner H, Siewert JR: Minimally invasive antireflux procedures.World J Surg 16:347–348, 1992

    Google Scholar 

  77. Morson BC, Belcher JR: Adenocarcinoma of the oesophagus and ectopic gastric mucosa.Br J Cancer 6:127–130, 1952

    Google Scholar 

  78. Yang PC, Davis S (SEER-Report): Incidence of cancer of the esophagus in the U.S. by histologic type.Cancer 61:612–617, 1988

    Google Scholar 

  79. Hesketh PJ, Clapp RW, Doos WG, Spechler SJ: The increasing frequency of adenocarcinoma of the esophagus.Cancer 64:526–530, 1989

    Google Scholar 

  80. Blot WJ, Devesa SS, Kneller RW: Rising incidence of adeno carcinoma of the esophagus and gastric cardia.JAMA 265:1287–1289, 1991

    Google Scholar 

  81. Wang HH, Antonioli DA, Goldman H: Comparative features of esophageal and gastric adenocarcinomas: recent changes in type and frequency.Hum Pathol 17:482–487, 1986

    Google Scholar 

  82. Powell J, McConkey CC: Increasing incidence of adenocarcinoma of the gastric cardia and adjacent sites.Br J Cancer 62:440–443, 1990

    Google Scholar 

  83. Rogers EL, Goldkin SF, Iser OA: Adenocarcinoma of the lower esophagus. A disease primarily of white men with Barrett's esophagus.J Clin Gastroenterol 8:613–618, 1986

    Google Scholar 

  84. Hamilton SR, Smith RRL, Cameron JL: Prevalence and characteristics of Barrett's esophagus in patients with adenocarcinoma of the esophagus or esophagogastric junction.Hum Pathol 19:942–948, 1988

    Google Scholar 

  85. Kalish RJ, Clancy PE, Orringer MB, Appleman HD: Clinical epidemiologic and morphologic comparison between adenocarcinomas arising in Barrett's esophageal mucosa and gastric cardia.Gastroenterology 86:461–467, 1984

    Google Scholar 

  86. Skinner DB, Walter BC, Riddel RH, Schmidt H, Iascone C, DeMeester TR: Barrett's esophagus: comparison of benign and malignant cases.Ann Surg 198:554–566, 1983

    Google Scholar 

  87. Levi F, Ollyo JB, La-Vecchia C, et al: The consumption of tobacco, alcohol, and the risk of adenocarcinoma in Barrett's oesophagus.Int J Cancer 45:852–854, 1990

    Google Scholar 

  88. Gray JR, Coldman AJ, MacDonald WC: Cigarette and alcohol use in patients with adenocarcinoma of the gastric cardia or lower esophagus.Cancer 69:2227–2231, 1992

    Google Scholar 

  89. Pera M, Cardesa A, Bombi JA, et al: Influence of esophagoduodenostomy on the induction of adenocarcinoma of the distal esophagus in Sprague-Dawley rats by subcutaneous injection of 2,6 dimethylnitrosomorpholine.Cancer Res 49:6803–6808, 1989

    Google Scholar 

  90. Attwood SEA, Smyrk TC, DeMeester TR, Mirvish S, Stein HJ, Hinder RA: Duodenoesophageal reflux and the development of esophageal adenocarcinoma in rats.Surgery 11:503–510, 1992

    Google Scholar 

  91. Hikasa Y, Tanida N, Ohno T, Shimoyama T: Fecal bile acid profiles in patients with large bowel cancer in Japan.Gut 25:833–838, 1984

    Google Scholar 

  92. Jagelman JG, DeCosse JJ, Bussey HJ: Upper gastro-intestinal cancer in familial polyposis.Lancet 1:1149–1151, 1988

    Google Scholar 

  93. Naef AP, Savary M, Ozello T: Columnar-lined lower esophagus: an acquired lesion with malignant predisposition. Report on 140 cases of Barrett's esophagus with 12 adenocarcinomas.J Thorac Cardiovasc Surg 70:826–835, 1975

    Google Scholar 

  94. Siewert JR, Weiser HF, Lepsien G, Peiper HJ: Endobrachyösophagus und Adenocarcinom der Speiseröhre.Chirurg 50:675–680, 1979

    Google Scholar 

  95. Moghissi K: Definition of adenocarcinoma arising in columnar epithelial-lined oesophagus (Barrett's adenocarcinoma).Dis Esoph 5:37–44, 1992

    Google Scholar 

  96. Siewert JR, Hölscher AH, Bollschweiler E: Surgical therapy of cancer in Barrett's esophagus.Dis Esophagus 5:57–62, 1992

    Google Scholar 

  97. Van der Veen AH, Dees J, Blankenstejin JD et al: Adenocarcinoma in Barrett's esophagus: an overrated risk.Gut 30:14–18, 1989

    Google Scholar 

  98. Borrie J, Goldwater L: Columnar cell-lined esophagus. Assessment of etiology and treatment.J Thorac Cardiovasc Surg 71:825–834, 1976

    Google Scholar 

  99. Spechler RW, Robbins AH, Rubins HB, et al: Adenocarcinoma and Barrett's esophagus: an overrated risk?Gastroenterology 87:927–933, 1984

    Google Scholar 

  100. Cameron AJ, Ott BJ, Payne WS: The incidence of adenocarcinoma in columnar lined (Barrett's) esophagus,N Engl J Med 313:857–860, 1985

    Google Scholar 

  101. Robertson CS, Mayberry JF, Nicolson DA, et al: Value of endoscopic surveillance in the detection of neoplastic change in Barrett's esophagus.Br J Surg 75:760–763, 1988

    Google Scholar 

  102. Hameeteman W, Tytgat GNJ, Houthoff HJ, van den Tweel JG: Barrett's esophagus: development of dysplasia and adenocarcinoma.Gastroenterology 96:1249–1256, 1989

    Google Scholar 

  103. Ovaska J, Miettinen M, Kivilaasko E: Adenocarcinoma arising in Barrett's esophagus.Dig Dis Sci 34:1336–1339, 1989

    Google Scholar 

  104. Polepalle SC, McCallum RW: Barrett's esophagus. Current assessment and future perspectives.Gastroenterol Clin N Am 19:733–744, 1990

    Google Scholar 

  105. Williamson W, Ellis FH, Gibb SP, Shahian DM, Aretz HT, Heatley GJ, Watkins E: Barrett's esophagus: prevalence and incidence of adenocarcinoma.Arch Int Med 151:2212–2216, 1991

    Google Scholar 

  106. Miros M, Kerlin P, Walker N: Only patients with dysplasia progress to adenocarcinoma in Barrett's oesophagus.GUT 32:1441–1446, 1991

    Google Scholar 

  107. Iftikhar SY, James PD, Steele RJC, Hardcastle JD, Atkinson M: Length of Barrett's oesophagus: an important factor in the development of dysplasia and adenocarcinoma.Gut 33:1155–1158, 1992

    Google Scholar 

  108. Achkar E, Carey WC: The cost of surveillance for adenocarcinoma complicating Barrett's esophagus.Am J Gastroenterol 83:291–294, 1988

    Google Scholar 

  109. Thompson JJ, Zeinsser KR, Enterline HT: Barrett's metaplasia and adenocarcinoma of the esophagus and gastroesophageal junction.Hum Pathol 14:42–60, 1983

    Google Scholar 

  110. Hamilton SR, Smith RRL: The relationship between columnar epithelial dysplasia and invasive adenocarcinoma arising in Barrett's esophagus.Am J Clin Pathol 87:301–312, 1987

    Google Scholar 

  111. Reid BJ, Weinstein WM, Lewin KJ, et al: Endoscopic biopsy can detect high-grade dysplasia or early adenocarcinoma in Barrett's esophagus without grossly recognizable neoplastic lesions.Gastroenterology 94:81–90, 1988

    Google Scholar 

  112. Schmid HG, Riddel RH, Walter B, Skinner DB, Riedmann JF: Dysplasia in Barrett's esophagus.J Cancer Res Clin Oncol 110:145–152, 1985

    Google Scholar 

  113. Reid BJ, Haggit RC, Rubin CE, et al: Observer variation in the diagnosis of dysplasia in Barrett's esophagus.Hum Pathol 19:166–178, 1988

    Google Scholar 

  114. Nishimaki T, Hölscher AH, Schuler M, Bollschweiler E, Becker K, Siewert JR: Histopathologic characteristics of early adenocarcinoma in Barrett's esophagus.Cancer 68:1731–1736, 1991

    Google Scholar 

  115. Pera M, Trastek VF, Carpenter HA, Allen MS, Deschamps C, Pairolero PC: Barrett's esophagus with high-grade dysplasia: an indication for esophagectomy?Ann Thor Surg 54:199–204, 1992

    Google Scholar 

  116. Schnell TG, Sontag SJ, Chejfec G: Adenocarcinoma arising in tongues or short segments of Barrett's esophagus.Dig Dis Sci 37:137–143, 1992

    Google Scholar 

  117. Schneider PM, Casson AG, Roth JA: Detection of malignant potential in Barrett's epithelium.Dis Esoph 5:45–50, 1992

    Google Scholar 

  118. Reid BJ, Haggit RC, Rubin CE: Barrett's esophagus: correlation between flow cytometry and histology in detection of patients at risk for adenocarcinoma.Gastroenterology 93:111, 1987

    Google Scholar 

  119. Haggitt RC, Reid BJ, Rabinovitch PS, Rubin CE: Barrett's esophagus: correlation between mucin histochemistry, flow cytometry, and histologic diagnosis for predicting increased cancer risk.Am J Clin Pathol 131:53–61, 1988

    Google Scholar 

  120. Reid BJ, Blount PL, Rubin CE: Flow-cytomeri and histological progression to malignancy in Barrett's esophagus: prospective endoscopic surveillance of a cohort.Gastroenterology 102:1212–1219, 1992

    Google Scholar 

  121. Jankowski J, Coghill G, Hopwood D, Wormsley KG: Oncogens and onco-suppressor gene in adenocarcinoma of the oesophagus.Gut 33:1033–1038, 1992

    Google Scholar 

  122. Blount PL, Ramel S, Raskind WH, et al: 17p allelic deletion and p53 over expression in Barrett's adenocarcinoma.Cancer Res 51:5482–5486, 1991

    Google Scholar 

  123. Casson AG, Mukopadhay T, Clearry KC, Ro JY, Levine B, Roth JA: p53 gene mutations in Barrett's epithelium and esophageal cancer.Cancer Res 52:4495–4499, 1991

    Google Scholar 

  124. Ramel S, Reid BJ, Sanchez CA: Evaluation of p53 protein expression in Barrett's esophagus by two-parameter flow cytometry.Gastroenterology 102:1220–1228, 1992

    Google Scholar 

  125. Palley SL, Sampliner R, Garewal HS: Management of highgrade dysplasia in Barrett's esophagus.J Clin Gastroenterol 11:369–372, 1989

    Google Scholar 

  126. Altorki NK, Sunagawa M, Little AG, Skinner DB: High-grade dysplasia in columnar-lined esophagus.Am J Surg 161:97–100, 1991

    Google Scholar 

  127. Hamilton SR, Hutcheon DF, Ravich WJ: Adenocarcinoma in Barrett's esophagus after elimination of gastroesophageal reflux.Gastroenterology 86:356–360, 1984

    Google Scholar 

  128. Tytgat GNJ, Hameeteman W: The neoplastic potential of columnar-lined (Barrett's) esophagus.World J Surg 16:308–312, 1992

    Google Scholar 

  129. Dittler HJ, Bollschweiler E, Siewert JR: Value of endosonography in the preoperative staging of oesophageal carcinoma.Dtsch Med Wochenschr 116:561–566, 1991

    Google Scholar 

  130. Moon MR, Schulte WJ, Haasler GB, Condon RE: Transhiatal and transthoracic esophagectomy for adenocarcinoma of the esophagus.Arch Surg 127:951–955, 1992

    Google Scholar 

  131. Siewert JR, Fink U: Multimodale Therapieprinzipien bei Tumoren des Gastrointestinaltrakts.Chirurg 63:242–250, 1992

    Google Scholar 

  132. Carey RW, Hilgenberg AD, Choi NC, Mathisen DJ, Grillo HC, Wain JC, Logan DL, Bromberg C: A pilot study of neoadjuvant chemotherapy with 5-fluorouracil and cisplatin with surgical resection and postoperative radiation therapy and/or chemotherapy in adenocarcinoma of the esophagus.Cancer 68:489–492, 1991

    Google Scholar 

  133. Urba SG, Orringer MB, Perez-Tamayo C, Bromberg J, Forrastiere A: Concurrent preoperative chemotherapy and radiation therapy in localized esophageal adenocarcinoma.Cancer 69:285–291, 1992

    Google Scholar 

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Stein, H.J., Siewert, J.R. Barrett's esophagus: Pathogenesis, epidemiology, functional abnormalities, malignant degeneration, and surgical management. Dysphagia 8, 276–288 (1993). https://doi.org/10.1007/BF01354551

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