title: [Detection of early neoplasia in Barrett's oesophagus: focus attention on index endoscopy in short-segment-Barrett's oesophagus with random biopsies].
abstract: BACKGROUND
  Detecting early neoplasias in Barrett's oesophagus (BE) is challenging. Recent publications have been focusing on improving the detection of such lesions during Barrett's surveillance. However in a recently published Danish register study calculating the risk for cancer-development in BE two-thirds of the diagnosed tumors were identified during the first examination or in the first year. This means that index endoscopy might be more effective than surveillance in detecting early neoplasia in BE.
  
  
  METHODS
  In the period from January 2010 to April 2011, all patients who consecutively presented with a diagnosis of early neoplastic changes in BE were recorded prospectively.
  
  
  METHODS
  The analysis included data for 121 patients. In patients with short-segment BE (SSBE), neoplasia was only diagnosed in 6 % of cases in the surveillance examination, compared with 44 % of cases in long-segment BE (LSBE). The neoplastic lesion was identified visually in 43 patients (36 %) during the external EGD. Type II tumours were detected in 40 % (39/98) and were correctly assessed as neoplastic in 25 % of cases (24/98).
  
  
  CONCLUSIONS
  1. in patients with SSBE almost all early tumours are diagnosed by index endoscopy and not by Barrett's surveillance; 2. around 40 % of all early neoplasias are endoscopically invisible and are only diagnosed using four-quadrant biopsies; 3. the macroscopic tumour type has a substantial influence on the detection rate for neoplasia. If efforts to increase the detection rate for early neoplasia in BE are focused solely on the Barrett's surveillance method, then only a minority of patients - 20 % in the present group - will benefit from the measure. German clinical trials register, DRKS00 004 168.
authors.affiliation: Klinik für Gastroenterologie und interventionelle Endoskopie, Vivantes Klinikum im Friedrichshain, Akademisches Lehrkrankenhaus der Humboldt Universität Berlin (Charité), Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Behrens
authors.affiliation: Klinik für Gastroenterologie und interventionelle Endoskopie, Krankenhaus Barmherzige Brüder Regensburg, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Pech
authors.affiliation: Klinik für Gastroenterologie, Dr. Horst Schmidt Kliniken, Wiesbaden, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Wuthnow
authors.affiliation: Klinik für Gastroenterologie, Dr. Horst Schmidt Kliniken, Wiesbaden, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Manner
authors.affiliation: Klinik für Gastroenterologie und interventionelle Endoskopie, Vivantes Klinikum im Friedrichshain, Akademisches Lehrkrankenhaus der Humboldt Universität Berlin (Charité), Berlin, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Pohl
authors.affiliation: Klinik für Gastroenterologie, Pneumologie, Hämatologie-Onkologie, Sana Klinikum Offenbach, Germany.
authors.forename: A
authors.initials: A
authors.lastname: May
authors.affiliation: Klinik für Gastroenterologie, Pneumologie, Hämatologie-Onkologie, Sana Klinikum Offenbach, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Ell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology*; D001706:Biopsy / Q000379:methods; D055088:Early Detection of Cancer / Q000379:methods*; D004938:Esophageal Neoplasms / Q000473:pathology*; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology*; D011897:Random Allocation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity