Perry, I.; Harrison, R.F.; Bryan, R.T.; Haddadin, W.; Taniere, P.; Shepherd, N.A.; Jankowski, J.A.Z.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA45
Academic Journal
Background: Intestinal Metaplasia within a Columnar Lined Oesophagus (Barrett's Oesophagus) is believed to be pre-malignant. At present it is not clear how best to diagnose this condition reliably when encountered at endoscopy. Objectives: We aimed to assess the frequency and distribution of intestinal metaplasia in 125 consecutive patients with endoscopically observed long segment Barrett's metaplasia to determine the optimal protocol for OGD and biopsy. In addition we assessed whether additional PAS histological staining would improve the diagnostic yield. Methods: A total of 1646 individual biopsies from 296 endoscoples performed on 125 patients were examined. Results: Intestinal metaplasia was demonstrated in 80/125 (64%) patients and 150/296 (51%) endoscopies, although only 557/1646 (34%) individual biopsies contained foci of intestinal metaplasia. Of 296 endoscopies, 166 contained cardiac mucosa, 158 fundic mucosa, 64 glandular mucosa of no special type and 111 squamous mucosa. The highest rate of intestinal metaplasia detection occurred when 8 biopsies per endoscopy were taken. However, there was a notable increase in the pick-up rate of intestinal metaplasia moving from 4 biopsies per endoscopy to 5 biopsies per endoscopy. Performing multiple endoscopies for individual patients resulted in only a modest increase in detection of intestinal metaplasia, with no new cases of intestinal metaplasia being diagnosed after the third endoscopy. While PAS staining identified only an extra 5.4% of new cases of intestinal metaplasia, it identified many more positive biopsies in those who were already known to have intestinal metaplasia. Conclusions: We recommend taking between 5 and 8 biopsies per endoscopy to reliably determine if a patient has intestinal metaplasia. Conventional H&E staining seems to be the mainstay of diagnosis.


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