Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2003 Jan;52(1):18-23.
doi: 10.1136/gut.52.1.18.

Biopsy surveillance is still necessary in patients with Barrett's oesophagus despite new endoscopic imaging techniques

K Egger  1 , M Werner, A Meining, R Ott, H-D Allescher, H Höfler, M Classen, T Rösch
Affiliations
Comparative Study

Biopsy surveillance is still necessary in patients with Barrett's oesophagus despite new endoscopic imaging techniques

K Egger et al. Gut. 2003 Jan.

Abstract

Background and aims: Endoscopic surveillance including stepwise four quadrant biopsies (4QB) is still regarded as the standard approach in patients with Barrett's oesophagus (BO). Several methods such as dye staining with methylene blue (MB) and tissue autofluorescence (AF) have been advocated to reduce the number of biopsies. We assessed their sensitivity and specificity compared with the standard approach-that is, endoscopy with 4QB-in the surveillance of a mixed BO population.

Patients and methods: Thirty five consecutive BO patients (mean age 64.9 years; 30 men, five women) were included in the study. AF endoscopy was followed by high resolution video endoscopy (VE) plus tissue staining with 0.5% MB. Biopsies were taken from any suspicious area found on any of the above tests, in addition to 4QB every 2 cm. The results were classified as either positive or negative for the various tests used. Histopathological results were used as the reference standard.

Results: In the 35 study patients, a total of 345 biopsies showed low grade dysplasia (LGD) in 88 biopsies, high grade dysplasia (HGD) in 19 biopsies, and carcinoma in 12 biopsies. The sensitivity and specificity rates for AF and MB for the diagnosis of cancer or dysplasia versus BO mucosa without dysplasia were 21%/91% and 37%/91%, respectively. 4QB revealed five cancer/HGD areas and 76 LGD areas not detected by AF, MB, or VE. The additional yield of MB and AF over VE with 4QB concerned only one HGD area (in the vicinity of a cancer) and seven LGD areas.

Conclusions: Due to their low sensitivity, AF and MB are not suitable techniques for reducing the high numbers of routine biopsies needed for finding additional foci of HGD or cancer. Careful endoscopic observation and stepwise four quadrant biopsy therefore still represent the gold standard for surveillance of Barrett's oesophagus.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Video endoscopy. Example of a patient with Barrett’s oesophagus without dysplasia.
Figure 2
Figure 2
Example of a patient with Barrett’s oesophagus with high grade dysplasia, negative on video endoscopy but positive on autofluorescence.
Figure 3
Figure 3
Video endoscopy. Example of a patient with Barrett’s oesophagus with low grade dysplasia, negative on video endoscopy but positive on methylene blue staining.
See this image and copyright information in PMC

Comment in

Comment on

  • S, m, l, xl.
    Wang T, Triadafilopoulos G. Wang T, et al. Gut. 2003 Jan;52(1):5-7. doi: 10.1136/gut.52.1.5. Gut. 2003. PMID: 12477746 Free PMC article. No abstract available.

References

    1. Hameeteman W, Tytgat GNJ, Houthoff HJ, et al. Barrett’s esophagus: development of dysplasia and adenocarcinoma. Gastroenterology 1989;96:1249–56. - PubMed
    1. Drewitz DJ, Sampliner RE, Garewal HS. Long term follow-up of Barrett’s cohort. Am J Gastroenterol 1997;92:212–15. - PubMed
    1. Dent J, Bremner CD, Collen MJ, et al. Working party report to the World Congress of Gastroenterology, Sydney, 1990: Barrett’s esophagus. J Gastroenterol Hepatol 1991;6:1–22. - PubMed
    1. Cameron AJ, Ott BJ, Payne WS. The incidence of adenocarcinoma in columnar-lined (Barrett’s) esophagus. N Engl J Med 1985;313:857–9. - PubMed
    1. Spechler SJ, Robbins AH, Rubins HB, et al. Adenocarcinoma and Barrett’s esophagus: an overrated risk? Gastroenterology 1984;87:927–33. - PubMed