Video-endoscopy for evaluation of columnar lined esophagus in patients with gastroesophageal reflux disease

Abstract

Zusammenfassung. Grundlagen: Angabe der Biopsielokalisation (Ösophagus vs. Magen) ist notwendig, um die histologische Diagnose von Reflux-assoziierten Verän-derungen am Übergang Ösophagus/Magen zu erstellen. Wir haben den Wert der Videoendoskopie für die Diagnostik am ösophagogastralen Übergang untersucht.Methodik: 29 konsekutive Patienten (m:w = 17:12) mit gastroösophagealer Refluxkrankheit (GERD) wurden prospektiv endoskopiert (EGD). EGD und Biopsien wurden digital aufgezeichnet und danach analysiert. Nach initialer histologischer Diagnose basierend auf dem ersten EGD-Befund erfolgte eine revidierte Diagnose basierend auf dem Befund nach EGD-Review.Ergebnisse: Bei 17 Patienten (59 %) stimmten revidierter und erster Befund überein (normale Junktion: n = 4; abnormale Junktion mit Zylinderepithelsegment im Ösophagus [CLE]: n = 13). Die Histologie zeigte Karditis (n = 3) und Cardia-intestinale Metaplasie (n = 1) in Patienten mit normaler Junktion; CLE (n = 8) und Ösophagus-intestinale Metaplasie (EIM) (n = 5) bei abnormaler Junktion (CLE ≤ 0,5-7 cm). Bei 12 Patienten (41 %) mit CLE ≤ 0,5 cm unterschied sich die revidierte Diagnose von der Erstdiagnose (abnormale Junktion: n = 12). Die Histopathologie zeigte CLE (n = 9) und Ösophagus-intestinale Metaplasie (n = 3). Die Misinterpretation resultierte aus kurzer Dauer der Sequenzen mit unbeeinträchtigter Sicht zur EGJ (< 0,001) und war unabhängig von der zirkulä-ren Ausdehnung der CLE-Segmente (p = 0,160). EIM zeigte sich nur in cardiac, nicht aber in oxyntocardiac Mukosa.Schlussfolgerungen: Bei der EGD werden Zylinderepithelsegmente im Ösophagus ≤ 0,5 cm zwar biopsiert, aber dem falschen Organ zugeordnet (Magen vs. Öso-phagus) und somit Vorläuferläsionen zum Barrett Ösopha-gus übersehen.Schlüsselwörter: Barrett Ösophagus, Kardia Mukosa, intestinale Metaplasie.Summary. Background: Information on biopsy location (esophageal vs. stomach) is required for histopathologic diagnosis of reflux associated morphologic changes at the esophagogastric junction (EGJ). We evaluated the impact of digital recording of esophagogastroduodenoscopy (EGD) on diagnosis of epithelial disorders of the EGJ.Methods: 29 consecutive patients (male:female = 17:12) with gastroesophageal reflux disease (GERD) prospectively underwent EGD. EGD including biopsy sampling from EGJ was digitally recorded and reviewed. Initial histopathology report based on the initial EGD-report was followed by a revised histopathology report based on a revised evaluation of endoscopy recording.Results: In 17 patients (59%) revised evaluation was in agreement with initial diagnosis (normal junction: n = 4; abnormal junction with columnar lined esophagus [CLE]: n = 13). Histopathology showed carditis (n = 3) and cardia intestinal metaplasia (n = 1) in patients with normal junction; CLE (n = 8) and esophagus intestinal metaplasia (EIM) (n = 5) for abnormal junctions (CLE ≤ 0.5-7 cm). In 12 patients (41%) with CLE ≤ 0.5 cm revised evaluation differed from initial reports (abnormal junction: n = 12). Histopathology showed CLE...

Videoendoscopy and histopathology of the esophagogastric junction in patients with gastroesophageal reflux disease

“…absence or presence of visible tongues of gastric-type mucosa above the level of the start of the rugal folds) [1,7,8,20]. Accordingly, Lenglinger et al [21] recently found that none of the biopsies obtained from a normal-appearing endoscopic esophagogastric junction contained direct transition from squamous epithelium to oxyntic mucosa. Thus, it is debatable whether the start of the gastric folds is an adequate landmark for defining the esophagogastric junction and whether the junction can be identified by endoscopy.…”

“…CLE with IM had been detected in a previous endoscopy). These five patients were part of a recent endoscopy study [21] that included biopsies from the endoscopically visible start of the gastric folds and any visible segment of gastric-type mucosa in the esophagus above this level. In contrast to the present study, biopsies were not obtained distal to the rise of the gastric folds [21].…”

“…Between January 19 and May 31, 2006, 35 consecutive patients (20 males) presenting at the University Clinic of Surgery, Vienna, with clinical signs of GERD, i.e. heartburn and regurgitation [22,23], prospectively underwent video-esophagogastroduodenoscopy (EGD) and biopsy sampling of the esophagogastric junction (see below) [21]. Endoscopies were conducted by three investigators each of whom routinely performs 250 EGDs per year.…”

“…We used videoendoscopy, a multilevel biopsy protocol and the histopathologic Paull-Chandrasoma classification of CLE [1,3,5,21]. We present the biopsy protocol and data obtained in the initial 35 patients of this study.…”

“…Difficulties in the diagnosis of CLE arise from different endoscopic, histologic and anatomic definitions of the esophagogastric junction [1,3,7,8,[16][17][18][19][20][21]. During endoscopy the esophagus is considered to end at the level of the start of the gastric folds [16,18,19].…”