Barrett Esophagus and Esophageal Cancer
Prague C and M criteria, surveillance intervals by dysplasia grade, RFA and EMR or ESD for dysplasia and early adenocarcinoma, and the divergent management pathways for adenocarcinoma versus squamous cell. Plus the biopsy protocol every fellow gets wrong on the wards.
- Audio chapterAttending-narrated, listen on the commute.
- ABIM-format MCQs5-option vignettes with full wrong-answer teaching.
- Study guideTables, decision trees, primary sources.
- AI tutorChapter-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 the boards reward candidates who keep three things straight in every vignette: 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
- 01
Barrett: Diagnosis, Pathogenesis, and Surveillance
Barrett esophagus lives at the intersection of a visible columnar segment at least 1 cm above the gastroesophageal junction and intestinal metaplasia on biopsy. This episode fixes the definition, the American versus British goblet-cell debate, the Prague criteria, and the dysplasia ladder that sets surveillance intervals. Board Pearls GI board review.
- 02
Endoscopic Eradication Therapy
Endoscopic eradication follows one principle: resect visible disease first because the specimen is the staging test, then ablate the flat Barrett field, with radiofrequency ablation as the workhorse and complete eradication of intestinal metaplasia as the endpoint. Covers EMR versus ESD, RFA, and cryotherapy. Board Pearls GI board review.
- 03
Esophageal Cancer: Staging and Treatment
Esophageal cancer splits into adenocarcinoma and squamous cell carcinoma, each with its own risk factors. This episode walks TNM staging with the T1a-versus-T1b boundary as the endoscopic-eligibility line, the EUS and PET workup, and the CROSS neoadjuvant chemoradiation regimen for locally advanced disease. Board Pearls GI board review.