Seattle protocol vs narrow band imaging guided biopsy in screening of Barrett's esophagus in gastroesophageal reflux disease patients

Abstract

Barrett's esophagus has 0.5% to 7% risk of progression to esophageal adenocarcinoma. The method of obtaining biopsies to diagnose Barrett's is challenging. Seattle protocol has been considered as the gold standard, however its difficulty limits its applicability in practice. Narrow band imaging guided biopsy has been proposed as an alternative. To investigate the accuracy, sensitivity, specificity and applicability of Narrow band guided biopsy as a screening tool for Barret's esophagus in gastroesophageal reflux patients. Endoscopy was done in 2 different sessions 2 weeks apart for 100 patients in Alexandria, Egypt. Patients had at least one of the following: Chronic Gastroesophageal reflux disease, frequent Gastroesophageal reflux disease, or two or more risk factors for Barrett's esophagus. All patients with known Barrett's esophagus were excluded. Seventeen patients had Barrett's esophagus either by one of the two techniques or by both, 4 patients by both methods, 7 patients by narrow band imaging alone and 6 patients by Seattle protocol alone (P < .001, κ = 0.461). Sensitivity, specificity, negative predictive value and positive predictive value for Seattle protocol were 58.8%, 100%, 92.2%, 100% vs 76.5%, 100%, 95.4%, 100% respectively for narrow band imaging. A mean of 7.73 samples/patient was taken in Seattle protocol vs 3.42 samples in narrow band imaging (P < .001). A mean of 8.63 minutes was consumed in Seattle protocol vs 2.65 minutes in narrow band imaging (P < .001). Narrow band imaging guided biopsy might have higher accuracy, sensitivity and negative predictive value as well as fewer number of biopsies and shorter time of the procedure compared to Seattle protocol which might increases its applicability as screening protocol for Barrett's esophagus. However, further larger multicentric studies are needed.

Diagnosis and Etiological Analysis of Gastroesophageal Reflux Disease by Gastric Filling Ultrasound and GerdQ Scale

“…Under normal circumstances, the anatomical structure of the lower segment of the stomach and esophagus can play an antireflux role. For example, His angle connecting the esophagus and stomach is a one-way valve to prevent reflux, while the abdominal esophagus is affected by abdominal pressure and plays an antireflux role by promoting the wall of the tube to converge [19][20][21]. However, when His angle increases, it means that the diaphragmatic angular clamp is weakened and cannot prevent the occurrence of reflux symptoms.…”

Therapeutic Upper Gastrointestinal Endoscopy in Pediatric Gastroenterology

“…Barrett's esophagus is a complication secondary to chronic acid exposure/reflux esophagitis resulting in columnar metaplasia of cells in the distal esophagus extending ≥1 cm proximal to the GEJ. Barrett's esophagus is a worrying condition as it is considered to be a major predisposing factor for development of adenocarcinoma conferring a 0.5% to 7% lifetime risk of developing malignancy, or approximately 0.66% per year in the adult population after development of dysplasia (61)(62)(63). Compared to prevalence in adults, that in children and adolescents is very low, ranging from 0.055 to 0.13% (63).…”

“…Identification of the GEJ is important, and biopsies are taken following the Seattle protocol (62). Over the years, several techniques have been developed, through which successful ablation is proposed: use of Nd-YAG laser (65,66), KTP (potassium titanyl phosphate) laser (67-69), multipolar electrocoagulation (70,71), APC (72)(73)(74), and photodynamic therapy (67,75,76).…”

The Use of Confocal Laser Endomicroscopy in Diagnosing Barrett’s Esophagus and Esophageal Adenocarcinoma

“…The main diagnostic method for BE is esophagogastroduodenoscopy ( Figure 3 a,b) with esophageal biopsies for histological examination. Finding of salmon-colored mucosa in the esophagus is typical for BE (segment ≥ 1 cm), while intestinal metaplasia is confirmed histopathologically [ 26 , 27 ]. Dysplastic BE includes LGD and HGD with higher risk of progression to EAC ( Figure 4 a,b).…”