The Goblet Cell: Is It Needed for a Diagnosis of Barrett’s Esophagus and Does It Impact Surveillance and Treatment?—CON

Abstract

Esophageal intestinal metaplasia generally is required for a diagnosis of Barrett’s esophagus (BE) and, in clinical practice, that intestinal metaplasia is identified by the presence of goblet cells. However, if BE is defined conceptually as an esophageal metaplasia that predisposes to adenocarcinoma, then the goblet cell becomes a very imperfect marker for that condition. False-positive diagnoses of BE can result from failure to distinguish true goblet cells from pseudogoblet cells, and false-negative diagnoses can result from inadequate biopsy sampling that misses goblet cells, which often are patchy in distribution. Furthermore, evidence is accumulating that there is a gastric foveolar pathway to esophageal adenocarcinoma that can occur in the absence of goblet cells, and that might be even more common and more aggressive than the familiar intestinal dysplasia pathway.