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News

Necessity of biopsy surveillance in Barrett's esophagus

Careful endoscopic observation and stepwise 4 quadrant biopsy represent the gold standard in the surveillance of Barrett's esophagus, find researchers in the January issue of Gut.

News image

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Endoscopic surveillance, including stepwise 4 quadrant biopsies (4QB), is the standard approach in patients with Barrett’s esophagus (BE).

However, methods such as staining with methylene blue (MB) and tissue autofluorescence (AF) have been suggested to reduce the number of biopsies performed.

In this study, a team from Germany assessed the sensitivity and specificity of these methods, compared to endoscopy with 4QB, in the surveillance of a mixed BE population.

The research team included 35 consecutive BE patients in the study. Patients had a mean age of 64.9 years, and included 30 men and 5 women.

AF endoscopy was followed by high resolution video endoscopy (VE) plus tissue staining with 0.5% MB.

In addition, the team took biopsies from any suspicious area found on any of the aBEve tests, in addition to 4QB every 2 cm.

They classified the results as either positive or negative for the various tests used.
Methylene blue and tissue autofluorescence not suitable techniques for reducing the high numbers of routine biopsies.
Gut

Histopathological results were used as the reference standard.

The research team took a total of 345 biopsies.

Of these, 88 showed low grade dysplasia (LGD), 19 showed high grade dysplasia (HGD), and 12 showed carcinoma.

The team found that sensitivity and specificity rates for AF and MB for the diagnosis of cancer or dysplasia, versus BE mucosa without dysplasia, were 21%/91% and 37%/91%, respectively.

Furthermore 4QB revealed 5 cancer or 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 1 HGD area and 7 LGD areas.

Dr Egger’s team concluded, “Due to their low 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 esophagus”.

Gut 2003; 52: 18-23
16 December 2002

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