Barrett Esophagus and Esophageal Cancer

• Audio chapter
  Single-voice audio, listen on the commute.
• ABIM-format MCQs
  5-option vignettes with full wrong-answer teaching.
• Study guide
  Tables, decision trees, primary sources.
• AI tutor
  Chapter-grounded, answers the question you're stuck on.

What this chapter covers

• Section 4.1: Barrett diagnosis and the Prague C and M criteria

  Barrett esophagus is a metaplastic response of the distal esophagus to chronic acid and bile injury, and three things must be kept straight: what the tissue is, how the extent is measured, and how the tissue is sampled.

• Section 4.2: Pathogenesis, dysplasia progression, and cancer risk

  Barrett esophagus is the price the distal esophagus pays for chronic acid and bile injury, and the cancer risk that follows is graded by dysplasia status.

• Section 4.3: Surveillance intervals and dysplasia management

  Surveillance intervals in Barrett are graded by dysplasia status and segment length, and the algorithm has tightened in the 2022 ACG guideline.

• Section 4.4: Endoscopic eradication therapy (EMR, RFA, ESD, cryotherapy)

  Endoscopic eradication therapy is the modality stack that has replaced esophagectomy for high-grade dysplasia and for most intramucosal cancer in Barrett.

• Section 4.5: Esophageal cancer staging and treatment

  Esophageal cancer divides into two histologies that share a tube but live different lives.

Podcast episodes

1. 01

   Barrett: Diagnosis, Pathogenesis, and Surveillance

   Episode one of the Barrett Esophagus and Esophageal Cancer chapter covers how to diagnose Barrett's, why the metaplasia climbs toward cancer, and how the dysplasia grade sets the surveillance interval. The organizing idea: the worse the cells look, the faster they progress, and that speed dictates how often you scope. American definition, sampling protocol, screening criteria, and grade-based intervals throughout.

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2. 02

   Endoscopic Eradication Therapy

   Endoscopic eradication of Barrett esophagus rests on one principle: the segment holds two kinds of tissue that demand two treatments in a fixed order. Resect visible disease first for a staging specimen, then ablate the flat metaplastic field. This episode covers EMR versus ESD, radiofrequency ablation, cryotherapy salvage, and the intensive post-eradication surveillance that recurrence at the junction and buried glands demands.

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3. 03

   Esophageal Cancer: Staging and Treatment

   Esophageal cancer from histology through staging to treatment, built around the one depth boundary that decides endoscopic versus surgical care. Covers adenocarcinoma versus squamous cell, T-stage depth categories, the mucosa-to-submucosa node-risk jump, the fixed staging workup, and the regimens for locally advanced and metastatic disease.

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Key topics

• ·Barrett's definition and the gastroesophageal junction
• ·Goblet-cell requirement and American versus British criteria
• ·Prague C and M measurement
• ·Seattle-style biopsy protocol and nodule resection
• ·Screening criteria and non-endoscopic tools
• ·Metaplasia-dysplasia-carcinoma sequence
• ·Dysplasia grading and expert confirmation
• ·Grade-based surveillance intervals
• ·Resect-first, ablate-second principle
• ·Endoscopic mucosal resection technique and staging value
• ·Endoscopic submucosal dissection indications
• ·Radiofrequency ablation of the flat field
• ·Cryotherapy and salvage modalities
• ·Complete eradication of intestinal metaplasia
• ·Post-eradication surveillance and buried glands
• ·Eradication failure and complications
• ·Adenocarcinoma vs squamous cell carcinoma
• ·Squamous risk factors and named associations
• ·T-stage depth categories and nodal staging
• ·Mucosal vs submucosal node-risk boundary
• ·Endoscopic vs surgical treatment selection
• ·Staging workup sequence
• ·Neoadjuvant and perioperative regimens
• ·Metastatic palliation and biomarker-directed therapy