Editing Barrett's oesophagus (section)

== '''Evaluation:''' ==

* Careful endoscopy - white     light and NBI are both useful
** Suspect when GOJ (proximal      extent of rugae) is >=1cm distal to the z-line
** Barrett's has a      characteristic salmon pink colour and velvety texture
** Firstly identify the segment      of columnar epithelium, and also look for areas of irregularity within it
** Use Prague classification      system (see 'endoscopy' topic)
** Note hiatal hernias
** Seattle protocol for      biopsies
* Oesophagitis + Barrett's
** If LA C or D oesophagitis is      found, the pathologist will have trouble identifying dysplasia and a      diagnosis of 'indeterminate' is likely
** If no concerns for cancer,      put them on high-dose PPI and re-scope in 6-8 weeks
* Irregular z-line:
** Found in 10-15% of patients
** When the SCJ lies above the      GOJ, but without any confluence, forming tongues shorter than 1cm, and      thus does not fulfil criteria for BO
** It can harbour histological      intestinal metaplasia, but the progression rate to BO is low, let alone      to malignancy, so no further evaluation or screening is recommended