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News

Detection of intestinal metaplasia in Barrett's esophagus

June's issue of The American Journal of Gastroenterology questions the number of biopsies needed for the diagnosis of intestinal metaplasia

News image

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Intestinal metaplasia (IM) and dysplasia in Barrett's esophagus are recognized surrogates for esophageal adenocarcinoma risk.

While few would argue with the "hunt for dysplasia," there is a divide regarding the usefulness of the histological confirmation of intestinal metaplasia in endoscopically-apparent long-segment Barrett's esophagus.

Dr Rebecca Harrison and colleagues from the UK, USA, Australia and Canada aimed to assess the frequency of intestinal metaplasia in 125 consecutive patients with columnar-lined esophagus and to determine the optimal biopsy protocol to detect intestinal metaplasia.

67.9% of endoscopies had intestinal metaplasia
The American Journal of Gastroenterology

296 endoscopies were performed over a 4-yr period in Barrett's esophagus segments of mean length 4 cm (range 1-11 cm) at a single center and the resulting biopsies were analyzed retrospectively.

Biopsies were all processed with routine hematoxylin and eosin (H&E) staining, and a subset (N = 92) was subject to alcian blue/periodic-acid Schiff staining.

Using H&E staining, the team found that the optimum number of biopsies to diagnose intestinal metaplasia was 8 per endoscopy, mean 67.9% endoscopies having intestinal metaplasia.

In contrast, if only 4 were taken the yield was 34.7% with intestinal metaplasia.

Unless more than 16 biopsies were taken (100% yield of intestinal metaplasia), no additional significant detection was achieved.

Using additional alcian blue/periodic-acid Schiff staining only had a marginal benefit, with 5.4% of new cases of intestinal metaplasia being identified.

There is a proximal cephalo-caudal gradient of intestinal metaplasia, especially with increased chronological age, but doing repeat endoscopies on patients did not increase the detection of intestinal metaplasia.

Dr Harrison concluded that, "At least 8 random biopsies is the minimum to be taken, and analyzed with conventional H&E staining, to diagnose benign intestinal metaplasia", and that "taking more biopsies did not statistically increase the diagnosis of intestinal metaplasia except when greater than 16 were taken when 100% yield was obtained".

The American Journal of Gastroenterology 2007; 102 (6), 1154-1161
11 June 2007

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