Short-Segment Barrett's Esophagus and Adenocarcinoma

Barrett's esophagus is a known risk factor for the development of adenocarcinoma of the esophagus and esophagogastric junction. Based on the length of the columnar segment at endoscopy, Barrett's esophagus has been arbitrarily separated into two broad categories: long-segment and short-segment. The rapid rise in the incidence of esophageal adenocarcinoma has generated sustained research interest in this lesion. Studies have shown that although the prevalence of short-segment Barrett's esophagus is higher than that of long-segment Barrett's esophagus, the risk of developing dysplasia and adenocarcinoma may actually be lower in those patients with short segment Barrett's esophagus. Nonetheless, both dysplasia and esophageal adenocarcinoma have been reported in patients with short-segment Barrett's esophagus, making this arbitrary distinction clinically unimportant. The current surveillance guidelines remain the same for both short- and long-segment Barrett's esophagus. Another key issue is differentiating short-segment Barrett's esophagus from intestinal metaplasia of the gastric cardia. The latter is distinct from esophageal intestinal metaplasia (ie, Barrett's esophagus) and probably does not warrant surveillance.