Magnifying endoscopy for the diagnosis of specialized intestinal metaplasia in short-segment Barrett's esophagus.
OBJECTIVE
To determine whether magnified observation of short-segment Barrett's esophagus (BE) is useful for the detection of specialized intestinal metaplasia (SIM).


METHODS
Thirty patients with suspected short-segment BE underwent magnifying endoscopy up to × 80. The magnified images were analyzed with respect to their pit-patterns, which were simultaneously classified into five epithelial types [I (small round), II (straight), III (long oval), IV (tubular), V (villous)] by Endo's classification. Then, a 0.5% solution of methylene blue (MB) was sprayed over columnar mucosa. The patterns of the magnified image and MB staining were analyzed. Biopsies were obtained from the regions previously observed by magnifying endoscopy and MB chromoendoscopy.


RESULTS
Three of five patients with a type V (villous) epithelial pattern had SIM, whereas 21 patients with a non-type V epithelial patterns did not have SIM. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of pit-patterns in detecting SIM were 100%, 91.3%, 92.3%, 60% and 100%, respectively (P = 0.004). Three of the 12 patients with positive MB staining had SIM, whereas 14 patients with negative MB staining did not have SIM. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of MB staining in detecting SIM were 100%, 60.9%, 65.4%, 25% and 100%, respectively (P = 0.085). The specificity and accuracy of pit-pattern evaluation were significantly superior compared with MB staining for detecting SIM by comparison with the exact McNemar's test (P = 0.0391).


CONCLUSIONS
The magnified observation of a short-segment BE according to the mucosal pattern and its classification can be predictive of SIM.
Nam Seok Ham, Jae Young Jang, Sung Woo Ryu, Ji Hye Kim, Eui Ju Park, Woong Cheul Lee, Kwang Yeun Shim, Soung Won Jeong, Hyun Gun Kim, Tae Hee Lee, Sung Ran Jeon, Jun Hyung Cho, Joo Young Cho, Institution for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul 140-743, South Korea.
Nam Seok
NS
Ham
Jae Young
JY
Jang
Sung Woo
SW
Ryu
Ji Hye
JH
Kim
Eui Ju
EJ
Park
Woong Cheul
WC
Lee
Kwang Yeun
KY
Shim
Soung Won
SW
Jeong
Hyun Gun
HG
Kim
Tae Hee
TH
Lee
Sung Ran
SR
Jeon
Jun Hyung
JH
Cho
Joo Young
JY
Cho
So Young
SY
Jin
Ji Sung
JS
Lee
D000293:Adolescent; D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000145:classification / Q000473:pathology*; D001706:Biopsy; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D055815:Young Adult
Barrett’s esophagus; Diagnosis; Dysplasia; Esophageal adenocarcinoma; Magnifying endoscopy; Methylene blue chromoendoscopy; Short-segment; Specialized intestinal metaplasia