Re: Cardiac rather than intestinal-type background in endoscopic resection specimens of minute Barrett adenocarcinoma.

摘要

I read with interest the manuscript by Takubo et al [1] regarding the type of mucosa adjacent to areas of adenocarcinoma in endoscopic resection specimens. The authors reported that nonintestinalized cardiac or fundic mucosa was more commonly present adjacent to the resected tumors than was intestinal-type mucosa. They concluded that in contrast to the current United States and German criteria for the definition of Barrett's esophagus, which requires the presence of intestinal metaplasia, the United Kingdom and Japanese definitions, which do not require the presence of intestinal metaplasia, would better define this disease. However, there is an important issue that is not addressed in the manuscript. It has been known since the landmark histologic study by Paull and colleagues [2] in 1976 that intestinal metaplasia is not uniformly distributed within a columnar-lined esophagus. Intestinal metaplasia, when present, is always found in the most proximal portion of the columnar segment and may extend throughout the columnar segment or may be limited to the proximal portion with cardiac and fundic mucosa located distally. This seminal study by Paull and colleagues [2] has been substantiated by others, and there is evidence that the density of goblet cells present within a Barrett's.segment diminishes the further distally you go as well [3].