title: Endoscopic characteristics of short-segment Barrett's esophagus, focusing on squamous islands and mucosal folds.
abstract: OBJECTIVE
  Endoscopic definitions of Barrett's esophagus (BE) vary among countries, mainly because of the difficulty in diagnosing short-segment BE (SSBE) endoscopically. The aim of this study was to investigate whether the endoscopic identification of squamous islands and the specific position of columnar epithelium helps improve the diagnosis of SSBE.
  
  
  METHODS
  First, we prospectively enrolled 100 consecutive patients with SSBE and evaluated the number of identified squamous islands in the columnar epithelium with different modalities: white light (WL), narrow band imaging (NBI), and iodine chromoendoscopy. Second, in another group of 100 consecutive patients with tongue-like SSBE, the correlation of the location of Barrett's mucosa to the esophageal longitudinal folds (ridge or valley) was evaluated endoscopically.
  
  
  RESULTS
  It was possible to detect squamous islands in 48, 71, and 75 patients by WL, NBI, and iodine chromoendoscopy, respectively. The detection rate of squamous islands by NBI or iodine chromoendoscopy was significantly superior to that by WL. Tongue-like SSBEs were predominantly found on the ridge of mucosal folds (71%), similar to the location of mucosal breaks (84%).
  
  
  CONCLUSIONS
  Squamous islands in the columnar epithelium were efficiently observed by NBI or iodine chromoendoscopy. SSBE was found more frequently on the ridges but not in the valleys of esophageal longitudinal mucosal folds. NBI endoscopic observation focusing on columnar epithelium with squamous islands on the ridges of distal esophageal folds may improve endoscopic detection of SSBE.
authors.affiliation: Second Department of Internal Medicine, Shimane University School of Medicine, Izumo, Japan.
authors.forename: Norihisa
authors.initials: N
authors.lastname: Ishimura
authors.forename: Yuji
authors.initials: Y
authors.lastname: Amano
authors.forename: Goichi
authors.initials: G
authors.lastname: Uno
authors.forename: Takafumi
authors.initials: T
authors.lastname: Yuki
authors.forename: Shunji
authors.initials: S
authors.lastname: Ishihara
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kinoshita
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology*; D016009:Chi-Square Distribution; D004396:Coloring Agents; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D004848:Epithelium / Q000473:pathology*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D007454:Iodides; D007564:Japan; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies
chemical_list: D004396:Coloring Agents; D007454:Iodides