Barrett Esophagus

Michael P. Federle, MD, FACR

Key Facts

Imaging

Mid-esophageal stricture with hiatal hernia and reflux is essentially pathognomonic
Long segment: Columnar epithelium > 3 cm above gastroesophageal (GE) junction
- Due to more severe reflux disease
- Hiatal hernia in almost all patients
- Mid-esophageal mucosal irregularity, stricture, ulceration (deep)
- Risk of cancer > short-segment type
Short segment: Columnar epithelium ≤ 3 cm above GE junction
- More common than long segment (2-12% at endoscopy of patients with reflux)
- Due to less severe reflux disease
- Distal esophageal reticular mucosa, ± stricture, ± ulceration (shallow)
Risk of adenocarcinoma based on morphology
- High risk: Mid-esophageal stricture, ulcer, reticular mucosa
- Moderate risk: Distal peptic stricture and reflux esophagitis
- Low risk: If none of above findings are present