Diagnostic accuracy of magnifying chromoendoscopy with detection of intestinal metaplasia and dysplasia using acetic acid in Barrett's esophagus.
OBJECTIVE
Endoscopy with systematic randomized biopsies aims to improve the detection of intestinal metaplasia (IM) and dysplasia in Barrett's esophagus (BE). Magnifying chromoendoscopy with alcoholic acetic acid might allow directed biopsies to improve detection of IM and dysplasia.


METHODS
Twenty-eight patients were studied with magnifying chromoendoscopy (Optical power zoom x 115, alcoholic acetic acid). Endoscopy biopsies were performed on one or several zones of BE chosen randomly, for which the chromoendoscopic pattern was determined according to Guelrud's classification.


RESULTS
Among seventy-two biopsies, the agreement between magnifying chromoendoscopy and histology and the positive predictive value of the association of patterns III and IV for the diagnosis of IM were 72.4%; sensibility and specificity were respectively 95.5% and 42.9%. The diagnostic accuracy was 75%. Among the six biopsies that showed high-grade dysplasia, three were suspected because of two particular patterns: local loss of ridged cerebriform pattern due to the disorganization of the mucosal folds and hypervascularization of the mucosa.


CONCLUSIONS
Magnifying chromoendoscopy with acetic acid allows targeted biopsies of the IM in BE and may help to detect high-grade dysplasia.
Service d'Hépato-Gastroentérologie, CHU d'Angers, Angers.
Stéphane
S
Réaud
Anne
A
Croue
Jean
J
Boyer
D019342:Acetic Acid; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology*; D001706:Biopsy; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D007202:Indicators and Reagents; D007422:Intestines / Q000473:pathology*; D008297:Male; D008679:Metaplasia / Q000175:diagnosis; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity
D007202:Indicators and Reagents; D019342:Acetic Acid