Résumé
L’œsophage de Barrett ou endobrachyœsophage prédispose à l’adénocarcinome de l’œsophage. Il est détecté en endoscopie, et doit être confirmé par la mise en évidence histologique d’une métaplasie intestinale (muqueuse «spécialisée») sur des biopsies endoscopiques. La signification de la présence de métaplasie intestinale sur des biopsies de la jonction œso-gastrique prélevées en l’absence d’aspect endoscopique évocateur reste débattue: segment «ultra-court» de muqueuse de Barrett, ou cardite avec métaplasie intestinale? La surveillance des patients porteurs d’un œsophage de Barrett est basée sur les biopsies systématiques et étagées de la muqueuse de Barrett à la recherche de dysplasie (ou néoplasie intra-épithéliale). De nombreuses classifications de la dysplasie ont été proposées, mais la plus utilisée est maintenant la classification dite de Riddell en dysplasie de bas grade et dysplasie de haut grade. Cette classification s’intègre aisément dans la classification de Vienne des néoplasies du tube digestif, dont le but est d’unifier les terminologies et les critères diagnostiques utilisés par les pathologistes en Occident et en Asie. Parmi les nombreux problèmes posés par l’utilisation de la dysplasie, sa reproductibilité diagnostique imparfaite, et son histoire naturelle imprévisible à l’échelon individuel sont les plus importants. Le rôle des pathologistes dans la prise en charge thérapeutique des lésions néoplasiques développées sur œsophage de Barrett est important, non seulement par l’étude des pièces opératoires en cas d’œsophagectomie, mais aussi par l’analyse des pièces de résection endoscopique (mucosectomie), pratiquées dans de nombreux centres, et qui pose des problèmes spécifiques. Il est possible que le développement de méthodes non biopsiques d’exploration de la muqueuse de Barrett modifie ce rôle dans les années à venir.
Summary
Barrett’s oesophagus or endobrachyoesophagus is a condition predisposing to oesophageal adenocarcinoma. It is detected by endoscopy and should be confirmed by the histological assessment of intestinal metaplasia (« specialized » mucosa) from endoscopic biopsies. The significance of the presence of intestinal metaplasia on biopsies of the oesogastric junction in the absence of suggestive endoscopic aspect remains debated. The follow up of patients with Barrett’s oesophagus relies on systematic randomized biopsies of Barrett’s mucosa searching for dysplasia (or intra-epithelial neoplasia). Numerous classifications of dysplasia have been proposed but the most frequently referred to is currently Riddell’s classification distinguishing low grade and high grade dysplasia. This classification is well integrated in the Vienna classification of digestive tract neoplasias, the aim of which is to standardize terminologies and diagnostic criteria used by pathologists from western countries and Asia. Among the various problems raised by the use of dysplasia, its imperfect reproducibility and its unpredictable natural history on an individual scale are the most important. The role of pathologists in the therapeutic management of neoplastic lesions developed on Barrett’s oesophageal is critical, not only from the standpoint of the study of surgical specimen after oesophagectomy but also from that of the analysis of samples resected by endoscopy (mucosectomy) performed in numerous centres and which raises specific problems. The development of non bioptic methods of investigation of Barrett’s mucosa might in the future modify this role.
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Références
Spechler SJ, Goyal RK. The columnar-lined esophagus, intestinal metaplasia and Norman Barrett. Gastroenterology 1996;110:614–621.
Sampliner E, and The Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol 2002;97:1888–1895.
Playford RJ. New British Society of Gastroenterology (BSG) guidelines for the diagnosis and management of Barrett’s oesophagus. Gut 2006;55:442.
Haggitt RC. Adenocarcinoma in Barrett’s esophagus: a new epidemic? Hum Pathol 1992;23:475–476.
Ronkainen J, Aro P, Storskrubb T, et al. Prevalence of Barrett’s esophagus in the general population: an endoscopic study. Gastroenterology 2005;129:1825–1831.
Scoazec J-Y. Tissue and cell imaging in situ: potential for applications in pathology and endoscopy. Gut 2003;52(Suppl IV):1–6.
Conio M, Cameron AJ, Chak A, Blanchi A, Filiberti R. Endoscopic treatment of high-grade dysplasia and early cancer in Barrett’s oesophagus. Lancet Oncol 2005;6:311–321.
Sharma P, Dent J, Armstrong G, et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology 2006;131:1392–1399.
Sharma P, Morales TG, Sampliner RE. Short segment Barrett’s esophagus — the need for standardization of the definition and endoscopic criteria. Am J Gastroenterol 1998;93:1033–1036.
Lambert R, Sharma P. Paris workshop on columnar metaplasia. Endoscopy 2005;37:879–920.
Paull A, Trier JS, Dalton MD, Camp RC, Loeb P, Goyal RK. The histologic spectrum of Barrett’s esophagus. N. Engl. J. Med. 1976;295:476–480.
Chatelain D, Flejou JF. High-grade dysplasia and superficial adenocarcinoma in Barrett’s esophagus: histological mapping and expression of p53, p21 and Bcl-2 oncoproteins. Virchows Arch. 2003;442:18–24.
Sharma P, McQuaid K, Dent J, et al. A critical review of the diagnosis and management of Barrett’s esophagus: the AGA Chicago workshop. Gastroenterology 2004;127:310–330.
Nurgalieva Z, Lowrey A, El-Serag HB. The use of cytokeratin stain to distinguish Barrett’s esophagus from contiguous tissues: a systematic review. Dig Dis Sci 2007;52:1345–1354.
Spechler SJ, Zeroogian JM, Antonioli DA. Prevalence of metaplasia at the gastroesophageal junction. Lancet 1994;92:414–418.
Odze RD. Unraveling the mystery of the gastroesophageal junction: a pathologist’s perspective. Am J Gastroenterol 2005;100:1853–1867.
Chandrasoma P. Controversies of the cardiac mucosa and Barrett’s esophagus. Histopathology 2005;46:361–373.
Cestari R, Villanacci V, Bassotti G, et al. The pathology of gastric cardia. Am J Surg Pathol 2007;31:706–710.
Hellier MD, Shepherd NA. Diagnosis of columnar-lined oesophagus. BSG guidelines in Gastroenterology, August 2005. (http://www.bsg.org.uk/bsgdispl.php?id=3f4a76385e42599499e9h=1=1i=1b=1m=00023).
Harrison R, Perry I, Haddadin W, et al. Detection of intestinal metaplasia in Barrett’s esophagus: an observational comparator study suggests the need for a minimum of eight biopsies. Am J Gastroenterol 2007;102:1154–1161.
Riddell RH, Goldman H, Ransohoff DF, et al. Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications. Hum. Pathol. 1983;14:931–968.
Werner M, Flejou JF, Hainaut P, et al. Adenocarcinoma of the oesophagus. In: Hamilton SR, Aaltonen LA (eds). Pathology and genetics of tumours of the digestive system. IARC Press, Lyon, 2000, 20–26.
Faller G, Borchard F, Ell C, et al. Histopathological diagnosis of Barrett’s mucosa and associated neoplasias: results of a consensus conference of the working group for gastroenterological pathology of the German Society for Pathology on 22 September 2001 in Erlangen. Virchows Arch 2003;443:597–601.
Offerhaus GJA, Correa P, van Eeden S, et al. Report of an Amsterdam working group on Barrett esophagus. Virchows Arch. 2003;443:601–607.
Geboes K, Van Eyken P. The diagnosis of dysplasia and malignancy in Barrett’s osophagus. Histopathology 2000;37:99–107.
Goldblum JR, Lauwers GY. Dysplasia arising in Barrett’s esophagus: diagnostic pitfalls and natural history. Semin Diagn Pathol 2002;19:12–19.
Odze RD. Diagnosis and grading of dysplasia in Barrett’s oesophagus. J Clin Pathol 2006;59:1029–1038.
Lomo, LC, Blount PL, Sanchez CA, et al. Crypt dysplasia with surface maturation: a clinical, pathologic, and molecular study of a Barrett’s esophagus cohort. Am J Surg Pathol 2006;30:423–435.
Thurberg BL, Duray PH, Odze RD. Polypoid dysplasia in Barrett’s esophagus: a clinicopathologic, immunohistochemical, and molecular study of five cases. Hum Pathol 1999;30:745–752.
Reid BJ, Haggitt RC, Rubin CE, et al. Observer variation in the diagnosis of dysplasia in Barrett’s esophagus. Hum Pathol 1988;19:166–178.
Alikhan M, Rex D, Khan A, Rahmani E, Cummings O, Ulbright TM. Variable pathologic interpretation of columnar lined esophagus by general pathologists in community practice. Gastrointest Endosc 1999;50:23–26.
Montgomery E, Bronner MP, Goldblum JR, et al. Reproducibility of the diagnosis of dysplasia in Barrett esophagus: a reaffirmation. Hum Pathol 2001;32:368–378.
Ormsby AH, Petras RE, Henricks WH, et al. Interobserver variation in Barrett’s related high grade dysplasia and superficial carcinoma: can it be improved using uniform pathological criteria? Gut 2002;51:671–676.
Kerkhof M, van Dekken H, Steyerberg EW, et al. Grading of dysplasia in Barrett’s oesophagus: substantial interobserver variation between general and gastrointestinal pathologists. Histopathology 2007;50:920–927.
Pech O, Vieth M, Schmitz D, et al. Conclusions from the histological diagnosis of low-grade intraepithelial neoplasia in Barrett’s oesophagus. Scand J Gastroenterol 2007;42:682–688.
Schlemper RJ, Riddell RH, Kato Y, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000;47:251–255.
Heitmiller RF, Redmond M, Hamilton SR. Barrett’s esophagus with high grade dysplasia. An indication for prophylactic esophagectomy. Ann Surg 1996;224:66–71.
Falk GW, Rice TW, Goldblum JR, Richter JE. Jumbo biopsy forceps protocol still misses unsuspected cancer in Barrett’s esophagus with high-grade dysplasia. Gastrointest Endosc 1999;49:170–176.
Levine DS, Haggitt RC, Blount PL, Rabinovitch PS, Rusch VW, Reid BJ. An endoscopic biopsy protocol can differentiate high-grade dysplasia from early adenocarcinoma in Barrett’s esophagus. Gastroenterology 1993;105:40–50.
Buttar N S, Wang KK, Sebo TJ, et al. Extent of high-grade dysplasia in Barrett’s esophagus correlates with risk of adenocarcinoma. Gastroenterology 2001;120:1630–1639?
Conio M, Blanchi S, Lapertosa G, et al. Long-term endoscopic surveillance of patients with Barrett’s esophagus. Incidence of dysplasia and adenocarcinoma: a prospective study. Am J Gastroenterol 2003;98:1912–1913.
Schnell TG, Sontag SJ, Chejfec G, et al. Long-term nonsurgical management of Barrett’s esophagus with high-grade dysplasia. Gastroenterology 2001;120:1607–1619.
Levine DS, Haggitt RC, Irvine S. Natural history of high-grade dysplasia in Barrett’s esophagus. Gastroenterology 1996;110:A550 (abstract).
Weston AP, Sharma P, Topalovski M, Richards R, Cherian R, Dixon A. Long-term follow-up of Barrett’s high-grade dysplasia. Am J Gastroenterol 2000;95:1888–1893.
Dar MS, Goldblum JR, Rice TW, Falk GW. Can extent of high grade dysplasia in Barrett’s oesophagus predict the presence of adenocarcinoma at oesophagectomy? Gut 2003;52:486–489.
Montgomery E, Goldblum JR, Greenson JK, et al. Dysplasia as a predictive marker for invasive carcinoma in Barrett esophagus: a follow-up study based on 138 cases from a diagnostic variability study. Hum Pathol 2001;32:379–388.
Skacel M, Petras R, Gramlich T, et al. The diagnosis of lowgrade dysplasia in Barrett’s esophagus and its implications for disease progression. Am J Gastroenterol 2000;95:3383–3387.
Srivastava A, Hornick JL, Li X, et al. Extent of low-grade dysplasia is a risk factor for the development of esophageal adenocarcinoma in Barrett’s esophagus. Am J Gastroenterol 2007;102:483–493.
Johnston JH. Technology insight: ablative techniques for Barrett’s esophagus — Current and emerging trends. Nature Clin Pract Gastroenterol Hepatol 2005;2:323–330.
Mino-Kenudson M, Brugge WR, Puricelli WP, et al. Management of superficial Barrett’s epithelium-related neoplasms by endoscopic mucosal resection. Clinicopathologic analysis of 27 cases. Am J Surg Pathol 2005;29:680–686.
Peters FP, Kara MA, Rosmolen WD, et al. Stepwise radical endoscopic resection is effective for complete removal of Barrett’s esophagus with early neoplasia: a prospective study. Am J Gastroenterol 2006;101:1449–1457.
Prasad GA, Wang KK, Lutzke LS, et al. Frozen section analysis of esophageal endoscopic mucosal resection specimens in the real-time management of Barrett’s esophagus. Clin Gastroenterol Hepatol 2006;4:173–178.
Hull MJ, Mino-Kenudson MM, Nishioka NS, et al. Endoscopic mucosal resection. An improved diagnostic procedure for early gastroesophageal epithelial neoplasms. Am J Surg Pathol 2006;30:114–118.
Fennerty MB, Corless CL, Sheppard B, Faigel DO, Lieberman DA, Sampliner RE. Pathological documentation of complete elimination of Barrett’s metaplasia following endoscopic multipolar electrocoagulation therapy. Gut 2001;49:142–144.
Mino-Kenudson M, Ban S, Ohana M, et al. Buried dysplasia and early adenocarcinoma arising in Barrett esophagus after porfimer-photodynamic therapy. Am J Surg Pathol 2007;31:403–409.
Hage M, Siersema PD, Vissers KJ, et al. Genomic analysis of Barrett’s esophagus after ablative therapy: persistence of genetic alterations at tumor suppressor loci. Int J Cancer 2006;118:155–160.
Hornick JL, Blount PL, Sanchez CA, et al. Biologic properties of columnar epithelium underneath reepithelialized squamous mucosa in Barrett’s esophagus. Am. J. Surg. Pathol 2005;29:372–380.
Ouatu-Lascar R, Fitzgerald RC, Triadafilopoulos G. Differentiation and proliferation in Barrett’s esophagus and the effects of acid suppression. Gastroenterology 1999;117:327–335.
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Fléjou, J.F. Œsophage de Barrett: rôle du pathologiste dans le diagnostic, la surveillance et la prise en charge thérapeutique. Acta Endosc 38, 117–128 (2008). https://doi.org/10.1007/BF02961949
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DOI: https://doi.org/10.1007/BF02961949