Classification of Barrett's epithelium by magnifying endoscopy.
BACKGROUND
The specialized columnar epithelium of Barrett's esophagus can be detected by obtaining random or 4 quadrant biopsy specimens at conventional endoscopy. However, little is known about the fine mucosal structure of specialized columnar epithelium.


METHODS
Thirty patients with Barrett's esophagus were studied by magnifying endoscopy. The fine mucosal pattern (pit pattern) of 67 regions in Barrett's mucosa was recorded and compared with methylene blue staining. Histologic, mucin immunohistologic, and cell proliferation analyses of biopsy specimens were performed in relation to the pit patterns determined by magnifying endoscopy.


RESULTS
Pit pattern was classified into 5 types. Tubular and villous pit patterns were not only characteristics of both specialized columnar epithelium and methylene blue absorption, but also possessed an intestinal mucin phenotype with a high Ki-labeling index, whereas other pit patterns (dot and straight) did not have specialized columnar epithelium and were categorized as the gastric phenotype. The long oval pit pattern had an intermediate phenotype between gastric and intestinal.


CONCLUSIONS
The classification of the superficial mucosal appearance of Barrett's epithelium by magnifying endoscopy reflects not only histologic features but also mucin phenotypes.
Endo
Takao
T
First Department of Internal Medicine, Sapporo Medical University, Sapporo 060, Japan.
Awakawa
Teruhito
T
Takahashi
Hiroaki
H
Arimura
Yoshiaki
Y
Itoh
Fumio
F
Yamashita
Kentaro
K
Sasaki
Sigeru
S
Yamamoto
Hiroyuki
H
Tang
Xiufen
X
Imai
Kohzoh
K
D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000145:classification* / Q000235:genetics / Q000473:pathology*; D003937:Diagnosis, Differential; D016145:Endoscopy, Digestive System; D004848:Epithelium / Q000473:pathology*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009077:Mucins / Q000235:genetics; D010641:Phenotype; D012680:Sensitivity and Specificity
D009077:Mucins