Detection of intestinal metaplasia in distal esophagus and esophagogastric junction by enhanced-magnification endoscopy.
BACKGROUND
Standard videoendoscopy identifies columnar-lined esophagus but cannot distinguish intestinal metaplasia from other types of epithelium. Enhanced-magnification endoscopy identifies different mucosal pit patterns. A preliminary study suggested that a type 3 pattern is associated with the presence of intestinal metaplasia. This study assesses the value of enhanced-magnification endoscopy for the detection of intestinal metaplasia in the distal esophagus and esophagogastric junction in patients undergoing diagnostic EGD.


METHODS
Patients undergoing diagnostic endoscopy for upper-GI symptoms underwent enhanced-magnification endoscopy after instillation of 1.5% acetic acid. The enhanced-magnification endoscopy mucosal pattern was classified into 3 types: 1, normal pits; 2, slit-reticular pattern; and 3, gyrus-villous pattern. Preliminary studies indicated that the type 3 pattern was related to intestinal metaplasia. One to 6 biopsies were targeted to areas having a type 3 pattern in columnar-appearing mucosa in the distal esophagus or esophagogastric junction. In the absence of type 3 pattern, one to 8 biopsies were targeted to areas with a type 2 pattern in columnar-appearing mucosa in the distal esophagus or esophagogastric junction.


RESULTS
The overall frequency of intestinal metaplasia in the esophagus and esophagogastric junction was 38.8% (26/67 patients). There was a good correlation between the type 3 pattern and intestinal metaplasia in targeted biopsy specimens (sensitivity 88.5%, specificity 90.2%, positive predictive value 85.2%, negative predictive value 92.5%, overall accuracy 90.0%).


CONCLUSIONS
Enhanced-magnification endoscopy is useful for detection of intestinal metaplasia in distal esophagus and esophagogastric junction.
Toyoda
Hideki
H
Department of Gastroenterology and Hepatology, Karolinska Hospital, Stockholm, Sweden.
Rubio
Carlos
C
Befrits
Ragnar
R
Hamamoto
Norihiro
N
Adachi
Yukihiko
Y
Jaramillo
Edgar
E
D019342:Acetic Acid / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000145:classification / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004943:Esophagogastric Junction / Q000473:pathology*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008679:Metaplasia / Q000175:diagnosis; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity
D019342:Acetic Acid