The value of traditional upper endoscopy as a diagnostic test for Barrett's esophagus.
BACKGROUND
The standard test for diagnosing Barrett's esophagus (BE) is a conventional upper endoscopy. However, studies have shown that confirmation of BE by endoscopy with histologic intestinal metaplasia can be difficult.


OBJECTIVE
To determine the overall accuracy, as well as factors that influence the accuracy of a conventional upper endoscopy in diagnosing BE.


METHODS
Thirteen academic, community, and Veterans Affairs sites.


METHODS
A retrospective data review.


METHODS
Patients who underwent an upper endoscopy with a finding of "suspected Barrett's esophagus" and esophageal biopsies. Pathology reports were examined to identify cases with intestinal metaplasia.


METHODS
Percentage of pathology-confirmed BE among suspected cases.


RESULTS
A total of 2511 procedures were examined; the frequency of biopsy-confirmed BE was 48.4%. Multivariate logistic regression identified the following factors to be independently associated with biopsy-confirmed BE: long-segment BE that measured > or = 3 cm (odds ratio [OR] 4.61 [95% CI, 3.73-5.69]), male sex (OR 1.82 [95% CI, 1.49-2.22]), increasing age (age interval 70-79 years with OR 2.33 compared with age <50 years [95% CI, 1.75-3.10]), the presence of a hiatal hernia (OR 1.46 [95% CI, 1.22-1.84]), and white race (OR 1.90 [95% CI, 1.49-2.22]).


CONCLUSIONS
Biopsy specimens were assumed to sample the tubular esophagus; the actual pathology slides were not reevaluated by the investigators.


CONCLUSIONS
Endoscopic evaluation has limitations for the diagnosis of BE. Specific patient and endoscopic characteristics may be associated with the confirmation of BE on biopsy specimens. Further study is needed to determine if new endoscopic imaging technologies improve the ability to correctly identify BE.
Department of Gastroenterology, Oregon Health and Science University, Portland, Oregon 97239, USA.
Amy
A
Wang
Nora C
NC
Mattek
Christopher L
CL
Corless
David A
DA
Lieberman
Glenn M
GM
Eisen
D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis* / Q000473:pathology; D001707:Biopsy, Needle; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged