title: Usefulness of endoscopic brushing and magnified endoscopy with narrow band imaging (ME-NBI) to detect intestinal phenotype in columnar-lined esophagus.
abstract: BACKGROUND
  Barrett's esophagus with specialized intestinal metaplasia (SIM), which is at high risk of progressing to esophageal adenocarcinoma, has been identified by obtaining biopsy specimens randomly. Magnified endoscopy with narrow band imaging (ME-NBI) is reported to be useful for detecting SIM or the intestinal phenotype. We aimed to evaluate the usefulness of endoscopic brushing followed by ME-NBI for the detection of the intestinal phenotype.
  
  
  METHODS
  Biopsy and brushing samples were taken following endoscopic observation by ME-NBI. Total RNA was extracted from the whole sample and microdissected samples, and quantitative reverse transcription-polymerase chain reaction (PCR) analysis of SHH, CDX2, and mucin mRNA expression was performed.
  
  
  RESULTS
  Fifty patients (32 men, 18 women, average age 67.3 years) with metaplastic columnar epithelium of the lower esophagus were studied. MUC2 (85 vs. 65 %) and CDX2 (95 vs. 75 %) were detected more frequently in the brushing samples than in the biopsy samples. MUC2 expression levels were significantly higher in the brushing samples than those in the biopsy samples. CDX2 and MUC2 expression levels in the brushing samples were significantly higher in the mucosa with tubular/villous pattern observed by ME-NBI than the levels in mucosae with other patterns.
  
  
  CONCLUSIONS
  Endoscopic brushing in mucosa of columnar epithelium with a tubular/villous pattern visualized by ME-NBI is useful to detect the intestinal phenotype.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan. murataka@med.kawasaki-m.ac.jp
authors.forename: Takahisa
authors.initials: T
authors.lastname: Murao
authors.forename: Akiko
authors.initials: A
authors.lastname: Shiotani
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Yamanaka
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Kimura
authors.forename: Hideaki
authors.initials: H
authors.lastname: Tsutsui
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Tomoari
authors.initials: T
authors.lastname: Kamada
authors.forename: Noriaki
authors.initials: N
authors.lastname: Manabe
authors.forename: Jiro
authors.initials: J
authors.lastname: Hata
authors.forename: Ken
authors.initials: K
authors.lastname: Haruma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000378:metabolism / Q000473:pathology*; D001706:Biopsy; D000071616:CDX2 Transcription Factor; D004848:Epithelium / Q000473:pathology; D020701:Esophagoscopes; D004947:Esophagus / Q000378:metabolism / Q000473:pathology*; D005260:Female; D005455:Fluorescent Antibody Technique; D018398:Homeodomain Proteins / Q000378:metabolism*; D006801:Humans; D061346:Laser Capture Microdissection; D008297:Male; D008679:Metaplasia / Q000378:metabolism / Q000473:pathology; D008875:Middle Aged; D055262:Mucin-2 / Q000378:metabolism*; D062048:Narrow Band Imaging / Q000379:methods*; D010641:Phenotype; D060888:Real-Time Polymerase Chain Reaction
chemical_list: D000071616:CDX2 Transcription Factor; C491270:CDX2 protein, human; D018398:Homeodomain Proteins; C524625:MUC2 protein, human; D055262:Mucin-2