Barrett's surveillance is prone to sampling error.
Dr Ragunath and colleagues from England assessed improving diagnostic accuracy of specialized intestinal metaplasia/dysplasia in Barrett's esophagus.
The research team determined whether enhanced magnification endoscopy using acetic acid instillation would improve this diagnostic accuracy.
The researchers examined the detection rate of the specialized intestinal metaplasia/dysplasia in 64 consecutive patients with Barrett's esophagus.
The team used acetic acid to enhance mucosal pit patterns.
Histology was compared with the previous findings at recent conventional surveillance in 62 patients.
|Histology showed specialized intestinal metaplasia in 77%, and adenocarcinoma in 5%|
|Alimentary Pharmacology & Therapeutics|
The team also examined the inter-/intra-observer agreement in the assessment of the enhanced magnification endoscopy pit pattern findings.
Histology revealed columnar-lined esophagus in 9% of patients, and specialized intestinal metaplasia in 77%.
The researchers found low-grade dysplasia in 8% of patients, high-grade dysplasia in 2%, and adenocarcinoma in 5%.
There was discordance between the histologic findings from conventional surveillance with random biopsy.
The team noted that 24% of patients had a histological upgrade with enhanced magnification endoscopy.
There was a high detection rate of 74% of specialized intestinal metaplasia even in short segment Barrett's esophagus.
The team observed that in addition, 2 cancers were detected, 1 with 2-cm Barrett's esophagus and the other ultra-short.
The mean kappa values for inter- and intra-observer agreement in assessing the pit patterns were about 0.6 and 0.7, respectively.
Dr Ragunath's team concludes, “Enhanced magnification endoscopy allows clear visualization of the epithelial pit patterns within Barrett's esophagus.”
“Targeted biopsy results in a high yield of specialized intestinal metaplasia and dysplasia.”