Biopsy surveillance is still necessary in patients with Barrett's oesophagus despite new endoscopic imaging techniques

Egger, K.; Werner, M.; Meining, A.; Ott, R.; Allescher, H.-D.; Höfler, H.; Classen, M.; Rösch, T.
January 2003
Gut;Jan2003, Vol. 52 Issue 1, p18
Academic Journal
Background and aims: Endoscopic surveillance including stepwise four quadrant biopsies (4QB) is still regarded as the standard approach in patients with Barrett's oesophagus (BO). Several methods such as dye staining with methylene blue (MB) and tissue autofluorescence (AF) have been advocated to reduce the number of biopsies. We assessed their sensitivity and specificity compared with the standard approach—that is, endoscopy with 4QB—in the surveillance of a mixed BO population. Patients and methods: Thirty five consecutive BO patients (mean age 64.9 years; 30 men, five women) were included in the study. AF endoscopy was followed by high resolution video endoscopy (VE) plus tissue staining with 0.5% MB. Biopsies were taken from any suspicious area found on any of the above tests, in addition to 4QB every 2 cm. The results were classified as either positive or negative for the various tests used. Histopathological results were used as the reference standard. Results: In the 35 study patients, a total of 345 biopsies showed Iow grade dysplasia (LGD) in 88 biopsies, high grade dysplasia (HGD) in 19 biopsies, and carcinoma in 12 biopsies. The sensitivity and specificity rates for AF and MB for the diagnosis of cancer or dysplasia versus BO mucosa without dysplasia were 21%/91% and 37%/91%, respectively. 4QB revealed five cancer/HGD areas and 76 LGD areas not detected by AF, MB, or VE. The additional yield of MB and AF over VE with 4QB concerned only one HGD area (in the vicinity of a cancer) and seven LGD areas. Conclusions: Due to their Iow sensitivity, AF and MB are not suitable techniques for reducing the high numbers of routine biopsies needed for finding additional foci of HGD or cancer. Careful endoscopic observation and stepwise four quadrant biopsy therefore still represent the gold standard for surveillance of Barrett's oesophagus.


Related Articles

  • CHROMOENDOSCOPY WITH METHYLENE BLUE IN BARRETT'S OESOPHAGUS: ADDING INSULT TO INJURY? Olliver, J.R.; Wild, C.P.; Sahay, P.; Dexter, S.P.L.; Hardie, L.J. // Gut;Apr2003 Supplement 1, Vol. 52, pA5 

    Chromoendoscopy with methylene blue (MB) is increasingly being applied during endoscopic examination of Barrett's oesophagus (BO). MB selectively stains specialised intestinal metaplasia as it is specifically absorbed by the goblet cells characterising this tissue. Experimental studies show that...

  • Resection of Benign Esophageal Stricture through a Minimally Invasive Endoscopic and Transgastric Approach. Lucktong, T.A.; Morton, John M.; Shaheen, Nicholas J.; Farrell, Timothy M. // American Surgeon;Aug2002, Vol. 68 Issue 8, p720 

    Recurrent benign esophageal strictures that are refractory to dilation can be difficult to manage. We report a novel technique for treatment of a recurrent esophageal stricture using a minimally invasive endoscopic and transgastric approach. The patient is a 40-year-old women who developed a...

  • S, M, L, XL …. Wang, T.; Triadafilopoulos, G. // Gut;Jan2003, Vol. 52 Issue 1, p5 

    Reports on methods of surveillance for Barrett's esophagus. Improvement of the small degree of resolution and tissue penetration to medium, large or even extra large levels of refinement, sensitivity and specificity; Use of a standard video endoscope in chromoendoscopy; Detection of...

  • EXPRESSION ANALYSIS OF THE METAPLASIA DYSPLASIA CARCINOMA SEQUENCE IN BARRETT'S OESOPHAGUS AND ADENOCARCINOMA. Penman, I.D.; Smith, V.; Shen, E.F.; Wieand, D.; Landon, T.H.; Wong, N.A.C.S.; Lessells, A.M.; Paterson-Brown, S.; Tang, J.Z.; Wu, T.; Hillan, K.J. // Gut;Apr2003 Supplement 1, Vol. 52, pA7 

    Introduction and Aims: The molecular genetic events involved in the metaplasia dysplasia carcinoma (MDC) sequence in Barrett's oesophagus (CLO) are incompletely understood. We applied microarray expression analysis of endoscopic biopsies to study further these events and to detect novel genes...

  • Temporal Changes in the Endoscopic Frequency of New Cases of Barrett's Esophagus in an Australian Health Region. Kendall, Bradley J.; Whiteman, David C. // American Journal of Gastroenterology;Jun2006, Vol. 101 Issue 6, p1178 

    OBJECTIVES: The number of patients diagnosed with Barrett's esophagus (BE) has increased in recent decades, although data from populations outside Europe and North America are scarce. This increase has significant implications for health resource utilization and costs. We sought to determine...

  • Improved Reflux Monitoring in the Acute Gastroesophageal Reflux Porcine Model Using Esophageal Multichannel Intraluminal Impedance Measurement. Müller-Stich, Beat Peter; Mehrabi, Arianeb; Kenngott, Hannes Götz; Mood, Zhoobin; Funouni, Hamidreza; Reiter, Michael Andreas; Linke, Georg Richard; Hinz, Ulf; Gutt, Carsten Nils; Köninger, Jörg // Journal of Gastrointestinal Surgery;Aug2008, Vol. 12 Issue 8, p1351 

    Background Acute animal models are needed to obtain further insights into the mechanism of gastroesophageal reflux disease. Existing acute models use imprecise methods to detect reflux. The aim of the present study was to evaluate the potential of esophageal multichannel intraluminal impedance...

  • Gastric Pseudopolyposis: A New Clinical Manifestation of Type A Gastritis. Ikeda, Tomosumi; Senoue, Issei; Hara, Masafumi; Tsutsumi, Yutaka; Harasawa, Shigeru; Miwa, Takeshi // American Journal of Gastroenterology;Feb1985, Vol. 80 Issue 2, p82 

    Three cases of type A gastritis associated with multiple polypoid lesions of the body of the stomach are presented. The endoscopic congo-red test showed the red to black color changes of the sprayed congo-red only on the top of the polypoid lesions. The endoscopic methylene-blue test revealed no...

  • Endoscopy II.  // Gut;Jul2012 Supplement, Vol. 61, pA267 

    The article presents abstracts on medical topics of Great Britain which include the cost of baristric surgery for endoscopy, indications of colonoscopy and the detection of dysplasia in Barrett's oesophagus.

  • Reflux Esophagitis: Effect of Oral Bethanechol on Symptoms and Endoscopic Findings. Thanik, Krishan D.; Chey, William Y.; Shah, Ashok N.; Gutierrez, Jorge G. // Annals of Internal Medicine;Dec80, Vol. 93 Issue 6, p805 

    Presents information on a study which examined the effectiveness of oral bethanechol on symptoms associated with esophagitis and the endoscopic evaluation of esophagitis in patients with asymptomatic reflux esophagitis. Materials and methodology; Results of the study.


Read the Article


Sign out of this library

Other Topics