Biopsy depth after radiofrequency ablation of dysplastic Barrett's esophagus.
BACKGROUND
After endoscopic radiofrequency ablation (RFA) of dysplastic Barrett's esophagus (BE), endoscopic biopsy samples are obtained to assess response to therapy. Whether these biopsies are of adequate depth to assess efficacy is unknown.


OBJECTIVE
To compare the depth of endoscopic biopsy samples after RFA with those of untreated controls and to determine the prevalence of subepithelial structures in endoscopic biopsy fragments.


METHODS
Secondary analysis of the AIM Dysplasia Trial, a multicenter, randomized, sham-controlled study.


METHODS
Nineteen treatment centers.


METHODS
Subjects with dysplastic BE, either status post RFA or ablation naïve (sham).


METHODS
The proportion of biopsy samples demonstrating subepithelial structures, stratified by tissue type (columnar vs squamous) in sham- and RFA-treated subjects.


RESULTS
A total of 5648 biopsy fragments were analyzed from 113 subjects (78 RFA, 35 sham; mean 50.0 fragments per subject). Most fragments (4653, 82.4%) contained subepithelium. Squamous biopsy samples from RFA and sham subjects demonstrated subepithelium at similar rates (78.4% vs 79.1%, respectively, P = not significant [NS]). Columnar biopsy samples from RFA and sham subjects also included subepithelium at similar rates (99.0% vs 98.8%, respectively, P = NS). Regardless of treatment assignment, more columnar than squamous biopsy samples demonstrated subepithelium (98.8% vs 78.5%, P < .001).


CONCLUSIONS
Biopsy samples were not individually mounted.


CONCLUSIONS
In both squamous and columnar tissue, endoscopic biopsy samples after RFA were as likely to demonstrate subepithelium as untreated controls. Almost 80% of all biopsy samples were adequate to evaluate for subsquamous intestinal metaplasia. The primary determinant of biopsy depth is the type of epithelium that underwent biopsy, with squamous less likely to yield subepithelium than columnar. Biopsy samples after RFA appear to be of adequate depth to assess response to therapy. (Clinical trial registration number NCT00282672.).
Shaheen
Nicholas J
NJ
Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7080, USA.
Peery
Anne F
AF
Overholt
Bergein F
BF
Lightdale
Charles J
CJ
Chak
Amitabh
A
Wang
Kenneth K
KK
Hawes
Robert H
RH
Fleischer
David E
DE
Goldblum
John R
JR
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology* / Q000601:surgery*; D001706:Biopsy; D017115:Catheter Ablation / Q000379:methods*; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000601:surgery*; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D011183:Postoperative Complications / Q000473:pathology* / Q000601:surgery*; D011230:Precancerous Conditions / Q000473:pathology* / Q000601:surgery*; D011237:Predictive Value of Tests; D016896:Treatment Outcome