A team from Lund, Sweden, investigated the endoscopic surveillance of columnar-lined esophagus (CLE). They examined the frequency of intestinal metaplasia detection and the impact of antireflux surgery.
A total of 177 patients were enrolled in a surveillance program for CLE. In each, the occurrence of intestinal metaplasia on biopsy samples was determined on repeated endoscopies.
In patients with no evidence of intestinal metaplasia on the two first endoscopies, the incidence of intestinal metaplasia on the subsequent endoscopies was evaluated.
This was compared in patients with medically and surgically treated gastroesophageal reflux disease.
| Prevalence of intestinal metaplasia increased with the number of endoscopies.
| Annals of Surgery |
Intestinal metaplasia was found in 53% of the 177 patients on their first surveillance endoscopy. It was more prevalent in long segments of CLE.
The prevalence of intestinal metaplasia was found to increase markedly with increasing number of surveillance endoscopies.
In addition, intestinal metaplasia tended to be detected early in patients with long segments of CLE. In patients with shorter segments, intestinal metaplasia was also detected late in the course of endoscopic surveillance.
The researchers found that patients with surgically treated reflux disease were 10 times less likely to develop intestinal metaplasia, compared with a group receiving standard medical therapy.
Dr Stefan Öberg, of the Department of Surgery, Lund University Hospital, said on behalf of his colleagues, "Biopsy samples from a single endoscopy, despite an adequate biopsy protocol, are insufficient to rule out the presence of intestinal metaplasia."
"Patients in whom biopsy specimens from a segment of CLE show no intestinal metaplasia have a significant risk of having undetected intestinal metaplasia or of developing intestinal metaplasia with time.
"Sampling error is probably the reason for the absence of intestinal metaplasia in segments of CLE longer than 4 cm. Development of intestinal metaplasia is common in patients with shorter segments of CLE," he added.
"Antireflux surgery protects against the development of intestinal metaplasia, possibly by better control of reflux of gastric contents," he concluded.