{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 4, Ep 1 of 3: Barrett: Diagnosis, Pathogenesis, and Surveillance","html":"","width":"100%","height":180,"duration":864,"description":"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.\n \nTopics covered\n\nBarrett's definition and the gastroesophageal junction\nGoblet-cell requirement and American versus British criteria\nPrague C and M measurement\nSeattle-style biopsy protocol and nodule resection\nScreening criteria and non-endoscopic tools\nMetaplasia-dysplasia-carcinoma sequence\nDysplasia grading and expert confirmation\nGrade-based surveillance intervals\n \n \nKey decisions\n\nBarrett's requires salmon columnar lining at least one centimeter above the junction PLUS intestinal metaplasia with goblet cells; use the American definition on exams.\nAny visible nodule or irregularity is resected, not forceps-biopsied, because resection also stages it; flat segment gets four-quadrant biopsies every two centimeters, tightened to every centimeter when dysplasia is present.\nEvery dysplasia call must be confirmed by a second pathologist with GI expertise before management changes; most community low-grade reads are downgraded on expert review.\nNon-dysplastic Barrett is scoped every five years for short segments and every three for long ones, but the first surveillance after a new diagnosis is at one year.\nIndefinite dysplasia and surveillance-path low-grade are managed with twice-daily acid suppression and repeat biopsy; confirmed low-grade in fit patients and essentially all high-grade go to endoscopic eradication.\nMucosal cancer carries little nodal risk and stays endoscopic; submucosal invasion raises node risk steeply and brings surgery into play.\n \n \nThis is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}