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Magnifying endoscopy for the diagnosis of specialized intestinal metaplasia in short-segment Barrett’s esophagus

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Author(s): Nam Seok Ham | Jae Young Jang | Sung Woo Ryu | Ji Hye Kim | Eui Ju Park | Woong Cheul Lee | Kwang Yeun Shim | Soung Won Jeong | Hyun Gun Kim | Tae Hee Lee | Sung Ran Jeon | Jun Hyung Cho | Joo Young Cho | So Young Jin | Ji Sung Lee

Journal: World Journal of Gastroenterology
ISSN 1007-9327

Volume: 19;
Issue: 41;
Start page: 7089;
Date: 2013;
Original page

Keywords: Short-segment | Barrett’s esophagus | Magnifying endoscopy | Methylene blue chromoendoscopy | Specialized intestinal metaplasia | Dysplasia | Esophageal adenocarcinoma | Diagnosis

ABSTRACT
AIM: To determine whether magnified observation of short-segment Barrett’s esophagus (BE) is useful for the detection of specialized intestinal metaplasia (SIM). METHODS: Thirty patients with suspected short-segment BE underwent magnifying endoscopy up to × 80. The magnified images were analyzed with respect to their pit-patterns, which were simultaneously classified into five epithelial types [I (small round), II (straight), III (long oval), IV (tubular), V (villous)] by Endo’s classification. Then, a 0.5% solution of methylene blue (MB) was sprayed over columnar mucosa. The patterns of the magnified image and MB staining were analyzed. Biopsies were obtained from the regions previously observed by magnifying endoscopy and MB chromoendoscopy. RESULTS: Three of five patients with a type V (villous) epithelial pattern had SIM, whereas 21 patients with a non-type V epithelial patterns did not have SIM. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of pit-patterns in detecting SIM were 100%, 91.3%, 92.3%, 60% and 100%, respectively (P = 0.004). Three of the 12 patients with positive MB staining had SIM, whereas 14 patients with negative MB staining did not have SIM. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of MB staining in detecting SIM were 100%, 60.9%, 65.4%, 25% and 100%, respectively (P = 0.085). The specificity and accuracy of pit-pattern evaluation were significantly superior compared with MB staining for detecting SIM by comparison with the exact McNemar’s test (P = 0.0391). CONCLUSION: The magnified observation of a short-segment BE according to the mucosal pattern and its classification can be predictive of SIM.
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