Magnification chromoendoscopy for the detection of intestinal metaplasia and dysplasia in Barrett's oesophagus

Abstract

Background: The presence of intestinal metaplasia (IM) in the columnar lined distal oesophagus defines Barrett's oesophagus with the risk of future malignant transformation. The distribution of both IM and dysplasia (low grade (LGD) and high grade (HGD)) within the columnar lined oesophagus is patchy and mosaic requiring random biopsies. Techniques that could help target areas of high yield within Barrett's mucosa would be helpful. Aim: To study the utility of high magnification chromoendoscopy (MCE) in the detection of IM, LGD, and HGD in patients with Barrett's oesophagus. Methods: Consecutive patients detected with columnar mucosa in the distal oesophagus were studied using an Olympus magnification endoscope (GIF-Q16OZ, 115×). The distal oesophagus was sprayed with indigo carmine solution and the oesophageal columnar mucosa patterns were noted under high magnification and targeted for biopsy. All biopsies were read by pathologists blinded to the endoscopic findings. Results: Eighty patients with suspected Barrett's oesophagus (that is, columnar lined distal oesophagus) were studied: mean age 62.7 years (range 35-81). Mean length of columnar mucosa was 3.7 cm (range 0.5-17). Three types of mucosal patterns were noted within the columnar mucosa after spraying indigo carmine and using MCE: ridged/villous pattern, circular pattern, and irregular/distorted pattern. The yield of IM on target biopsies according to the patterns was: ridged/villous 57/62 (97%) and circular 2/12 (17%). Six patients had an irregular/distorted pattern and all had HGD on biopsy (6/6 (100%)). Eighteen patients had LGD on target biopsies; all had the ridged/villous pattern. All patients with long segment Barrett's were identified using MCE whereas 23/28 patients (82%) with short segment Barrett's had the ridged/villous pattern. Conclusions: MCE helps visually identify areas with IM and HGD having specific patterns but not patients with LGD (appear similar to IM). MCE may be a useful clinical tool for the increased detection of patients with IM as well as for surveillance of patients for the detection of HGD. If these preliminary results are validated, MCE would help identify high yield areas, potentially eliminating the need for random biopsies.

Magnifying Endoscopy and Chromoendoscopy in Upper Gastrointestinal Tract - Clinical Applications

“…patients with BE which corresponded to HGD on biopsy specimens. They did not identify a specific pattern corresponding to low-grade dysplasia (LGD) in these patients (Sharma et al, 2003). Vascular patterns are better identified with narrow band imaging (NBI) than with chromoendoscopy, because the blood vessels may be masked by the use of stains.…”

Diffuse reflectance spectroscopy in Barrett’s Esophagus: developing a large field‐of‐view screening method discriminating dysplasia from metaplasia

“…Whereas conventional endoscopy is limited to detecting lesions based on gross morphological changes, several novel optically based technologies offer the potential of detecting the very earliest mucosal changes. Spectral techniques, particularly fluorescence [7,8] and narrow-band imaging [9], optical coherence tomography [10,11] laser scattering spectroscopy [12], Raman spectroscopy [13], microendoscopy [14], chromoendoscopy [15,16], chromomicroendoscopy [17] and infrared endoscopy [18] have all been investigated, with variable results. The spectral techniques are currently limited to pointby-point sampling only.…”

Optimizing the diagnosis and therapy of Barrett’s esophagus

“…Amplification of endoscopic images with magnifying endoscopes has shown to be useful in the visualization of mucosal changes with good imaging resolution (31). Its use in combination with other techniques such as chromoendoscopy improves the detection of IM and HGD in patients with detected columnar metaplasia (32).…”