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Non-biopsy detection of intestinal metaplasia and dysplasia in Barrett's esophagus: a prospective multicenter study.
Endoscopy. 2006 Dec; 38(12):1206-12.E

Abstract

BACKGROUND AND STUDY AIMS

There have been no multicenter studies investigating the use of magnification chromoendoscopy (MCE) for the detection of intestinal metaplasia and dysplasia/cancer in Barrett's esophagus. Our aims were to assess the ability of MCE to predict the histological diagnosis (non-biopsy detection), to compare the yield of MCE-targeted versus random biopsies for dysplasia, and to compare procedure times.

PATIENTS AND METHODS

In this prospective multicenter study, patients with known or suspected Barrett's esophagus underwent MCE with indigo carmine dye staining. Three mucosal patterns (ridge/villous, circular, and irregular/distorted) were standardized, based on past experience. Mucosal patterns were noted and target biopsies were obtained only if irregular/distorted patterns were identified. Otherwise, random four-quadrant biopsies were obtained.

RESULTS

A total of 56 patients (mean age 64 years, mean length of Barrett's esophagus 2.7cm) were prospectively evaluated: 38 patients (67.8 %) had ridge/villous patterns, four patients (7.1 %) had circular patterns, four patients (7.1 %) had irregular/distorted patterns, and ten patients (17.8 %) had a combination of patterns. Histologically, intestinal metaplasia was not shown in eight patients (14.2 %), nondysplastic Barrett's esophagus was diagnosed in 30 patients (53.5 %), low-grade dysplasia was detected in 12 patients (21.4 %), and high-grade dysplasia was detected in six patients (10.7 %). An irregular/distorted pattern either throughout the entire segment of Barrett's esophagus or in combination with a ridge/villous or circular pattern had a sensitivity or 83 %, a specificity of 88 %, a positive predictive value of 45 %, and a negative predictive value of 98 % for high-grade dysplasia. The yield of high-grade dysplasia was similar for the two techniques but the time taken to perform MCE was less than the time taken to perform random biopsies.

CONCLUSION

An irregular/distorted pattern is specific for high-grade dysplasia and so it may not be necessary to perform biopsies in patients with ridge/villous or circular mucosal patterns.

Authors+Show Affiliations

University of Kansas School of Medicine and Veterans Affairs Medical Center, Kansas City, MO, USA. psharma@kumc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17163320

Citation

Sharma, P, et al. "Non-biopsy Detection of Intestinal Metaplasia and Dysplasia in Barrett's Esophagus: a Prospective Multicenter Study." Endoscopy, vol. 38, no. 12, 2006, pp. 1206-12.
Sharma P, Marcon N, Wani S, et al. Non-biopsy detection of intestinal metaplasia and dysplasia in Barrett's esophagus: a prospective multicenter study. Endoscopy. 2006;38(12):1206-12.
Sharma, P., Marcon, N., Wani, S., Bansal, A., Mathur, S., Sampliner, R., & Lightdale, C. (2006). Non-biopsy detection of intestinal metaplasia and dysplasia in Barrett's esophagus: a prospective multicenter study. Endoscopy, 38(12), 1206-12.
Sharma P, et al. Non-biopsy Detection of Intestinal Metaplasia and Dysplasia in Barrett's Esophagus: a Prospective Multicenter Study. Endoscopy. 2006;38(12):1206-12. PubMed PMID: 17163320.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Non-biopsy detection of intestinal metaplasia and dysplasia in Barrett's esophagus: a prospective multicenter study. AU - Sharma,P, AU - Marcon,N, AU - Wani,S, AU - Bansal,A, AU - Mathur,S, AU - Sampliner,R, AU - Lightdale,C, PY - 2006/12/14/pubmed PY - 2007/2/22/medline PY - 2006/12/14/entrez SP - 1206 EP - 12 JF - Endoscopy JO - Endoscopy VL - 38 IS - 12 N2 - BACKGROUND AND STUDY AIMS: There have been no multicenter studies investigating the use of magnification chromoendoscopy (MCE) for the detection of intestinal metaplasia and dysplasia/cancer in Barrett's esophagus. Our aims were to assess the ability of MCE to predict the histological diagnosis (non-biopsy detection), to compare the yield of MCE-targeted versus random biopsies for dysplasia, and to compare procedure times. PATIENTS AND METHODS: In this prospective multicenter study, patients with known or suspected Barrett's esophagus underwent MCE with indigo carmine dye staining. Three mucosal patterns (ridge/villous, circular, and irregular/distorted) were standardized, based on past experience. Mucosal patterns were noted and target biopsies were obtained only if irregular/distorted patterns were identified. Otherwise, random four-quadrant biopsies were obtained. RESULTS: A total of 56 patients (mean age 64 years, mean length of Barrett's esophagus 2.7cm) were prospectively evaluated: 38 patients (67.8 %) had ridge/villous patterns, four patients (7.1 %) had circular patterns, four patients (7.1 %) had irregular/distorted patterns, and ten patients (17.8 %) had a combination of patterns. Histologically, intestinal metaplasia was not shown in eight patients (14.2 %), nondysplastic Barrett's esophagus was diagnosed in 30 patients (53.5 %), low-grade dysplasia was detected in 12 patients (21.4 %), and high-grade dysplasia was detected in six patients (10.7 %). An irregular/distorted pattern either throughout the entire segment of Barrett's esophagus or in combination with a ridge/villous or circular pattern had a sensitivity or 83 %, a specificity of 88 %, a positive predictive value of 45 %, and a negative predictive value of 98 % for high-grade dysplasia. The yield of high-grade dysplasia was similar for the two techniques but the time taken to perform MCE was less than the time taken to perform random biopsies. CONCLUSION: An irregular/distorted pattern is specific for high-grade dysplasia and so it may not be necessary to perform biopsies in patients with ridge/villous or circular mucosal patterns. SN - 0013-726X UR - https://www.unboundmedicine.com/medline/citation/17163320/Non_biopsy_detection_of_intestinal_metaplasia_and_dysplasia_in_Barrett's_esophagus:_a_prospective_multicenter_study_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2006-944974 DB - PRIME DP - Unbound Medicine ER -