Subsquamous Intestinal Metaplasia: Implications for Endoscopic Management of Barrett's Esophagus  Patrick Yachimski, Gary W. Falk  Clinical Gastroenterology and Hepatology  Volume 10, Issue 3, Pages 220-224 (March 2012) DOI: 10.1016/j.cgh.2011.10.009 Copyright © 2012 AGA Institute Terms and Conditions

Figure 1 BE is defined as intestinal metaplasia of the distal esophagus, in which normal squamous epithelium (A) is replaced by columnar epithelium (B), typically following chronic gastric acid and/or duodenal bile acid reflux. SSIM can be detected in some patients with BE following long-term treatment with PPIs and either before or after endoscopic ablation therapy. SSIM may exist in the absence of endoscopically visible columnar epithelium characteristic of BE (C) or may coexist with endoscopically visible BE (D). In some instances, careful histopathologic analysis may demonstrate that SSIM connects with the mucosal surface and visible BE (E). Relatively protected from luminal acid exposure, SSIM possesses unique biologic properties compared with surface epithelium (lower panel). Clinical Gastroenterology and Hepatology 2012 10, 220-224DOI: (10.1016/j.cgh.2011.10.009) Copyright © 2012 AGA Institute Terms and Conditions

Figure 2 Histopathology analysis demonstrates glandular epithelium beneath squamous epithelium, consistent with SSIM or buried Barrett's; (A) 4× magnification; (B) 10× magnification. Images courtesy of Chanjuan Shi. Clinical Gastroenterology and Hepatology 2012 10, 220-224DOI: (10.1016/j.cgh.2011.10.009) Copyright © 2012 AGA Institute Terms and Conditions