Background and aims
Endoscopy can be used to monitor the onset of metaplastic transformation and to observe the progression of neoplasia in small animal models of Barrett’s esophagus. By avoiding animal sacrifice, the natural history of this disease can be studied in a longitudinal fashion. We aim to characterize the endoscopic features of esophageal mucosa at various stages of the metaplasia-dysplasia-carcinoma sequence in a rat reflux model of Barrett’s for comparison with histology.
Methods
Acid and bile reflux was produced by introducing a side-to-side esophago-gastro-jejunostomy in Sprague-Dawley rats. Endoscopic examination of the distal esophagus was performed in 24 surgically-altered and 4 control rats, between weeks 24 to 36 after the operation in 4 week intervals, and all rats were biopsied and sacrificed at 36 weeks. Endoscopic images were classified based on the surface mucosal patterns of the distal esophagus and then compared to histology. The endoscopic appearance were classified as: 1) normal, characterized by a smooth surface; 2) intestinal metaplasia, defined as elevated plaques/ridges, deep grooves and thin linear folds; 3) dysplasia, indicated by coarse folds/grooves, mesh-like villi, and foveolar appearance, and 4) carcinoma, suggested by irregular shaped mass lesions with ulcerations.
Results
The endoscopic criteria for intestinal metaplasia yielded a sensitivity of 100% in comparison to histology. Intestinal metaplasia with high-grade dysplasia was found in 2 rats and with low-grade dysplasia in 3 rats. Both focally-invasive squamous cell carcinoma and invasive adenocarcinoma were found in 1 rat.
Conclusions
Small animal endoscopy in a rat model of Barrett’s esophagus can be used to perform surveillance, classify mucosal patterns, observe the onset of intestinal metaplasia, and monitor the progression of neoplastic transformation, representing a useful tool for studying the natural history of this disease.