title: Adequacy of esophageal squamous mucosa specimens obtained during endoscopy: are standard biopsies sufficient for postablation surveillance in Barrett's esophagus?
abstract: BACKGROUND
  After endoscopic eradication therapy (EET) for Barrett's esophagus (BE), surveillance of residual/recurrent intestinal metaplasia/dysplasia including subsquamous tissue is performed by using biopsy forceps.
  
  
  OBJECTIVE
  The goal of this study was to compare the adequacy of biopsy specimens obtained from neo-squamous (post-EET patients) and native (non-BE patients) squamous mucosa.
  
  
  METHODS
  A case-control study using squamous biopsy specimens obtained at 2 tertiary referral centers was conducted.
  
  
  METHODS
  Two experienced GI pathologists reviewed specimens from patients with neo- (post-EET patients) and native (non-BE patients) squamous mucosa in a blinded fashion after developing standardized criteria to assess tissue depth.
  
  
  METHODS
  The primary outcome was the proportion of biopsy specimens that contained any amount of lamina propria.
  
  
  RESULTS
  A total of 193 biopsy specimens (1692 tissue pieces) from 104 patients were reviewed: 163 neo- and 30 native squamous. Of all biopsy specimens, only 37% contained any amount of lamina propria, and, furthermore, fewer than 4% of specimens had sufficient lamina propria (ie, more than two thirds of the entire squamous tissue present). When examining individual squamous tissue pieces, fewer than 11% contained lamina propria. No statistically significant differences in the presence of lamina propria were detected between neo- and native squamous mucosa.
  
  
  CONCLUSIONS
  The majority of esophageal squamous biopsy specimens obtained during endoscopy do not demonstrate lamina propria and subepithelial structures. This is true for both neo- and native squamous mucosa. Biopsy specimens of neo-squamous mucosa obtained after EET appear to be inadequate to exclude subsquamous intestinal metaplasia/dysplasia because lamina propria is not present in more than 60% of specimens. This has larger implications in the clinical management of BE patients after EET.
authors: Department of Gastroenterology, Veterans Affairs Medical Center, Kansas City, MO, USA.
authors: Neil
authors: N
authors: Gupta
authors: Sharad C
authors: SC
authors: Mathur
authors: John A
authors: JA
authors: Dumot
authors: Vikas
authors: V
authors: Singh
authors: Srinivas
authors: S
authors: Gaddam
authors: Sachin B
authors: SB
authors: Wani
authors: Ajay
authors: A
authors: Bansal
authors: Amit
authors: A
authors: Rastogi
authors: John R
authors: JR
authors: Goldblum
authors: Prateek
authors: P
authors: Sharma
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology* / Q000601:surgery; D001706:Biopsy / Q000592:standards*; D016022:Case-Control Studies; D004945:Esophagoscopy / Q000592:standards*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D015588:Observer Variation; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D018571:Sentinel Surveillance