Detection of intestinal metaplasia in distal esophagus and esophagogastric junction by enhanced-magnification endoscopy

• Published in: Gastrointestinal endoscopy 2004, Vol.59 (1), p.15-21
• Main Authors: Toyoda, Hideki, Rubio, Carlos, Befrits, Ragnar, Hamamoto, Norihiro, Adachi, Yukihiko, Jaramillo, Edgar
• Format: Article
• Language: English
• Subjects: Acetic Acid - administration & dosage; Adult; Aged; Aged, 80 and over; Barrett Esophagus - classification; Barrett Esophagus - pathology; Biological and medical sciences; Endoscopy, Gastrointestinal - methods; Esophagogastric Junction - pathology; Esophagus - pathology; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Image Enhancement; Male; Medical sciences; Medicin och hälsovetenskap; Metaplasia - diagnosis; Middle Aged; Other diseases. Semiology; Prospective Studies; Sensitivity and Specificity; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/S0016-5107(03)02527-6

Standard videoendoscopy identifies columnar-lined esophagus but cannot distinguish intestinal metaplasia from other types of epithelium. Enhanced-magnification endoscopy identifies different mucosal pit patterns. A preliminary study suggested that a type 3 pattern is associated with the presence of intestinal metaplasia. This study assesses the value of enhanced-magnification endoscopy for the detection of intestinal metaplasia in the distal esophagus and esophagogastric junction in patients undergoing diagnostic EGD. Patients undergoing diagnostic endoscopy for upper-GI symptoms underwent enhanced-magnification endoscopy after instillation of 1.5% acetic acid. The enhanced-magnification endoscopy mucosal pattern was classified into 3 types: 1, normal pits; 2, slit-reticular pattern; and 3, gyrus-villous pattern. Preliminary studies indicated that the type 3 pattern was related to intestinal metaplasia. One to 6 biopsies were targeted to areas having a type 3 pattern in columnar-appearing mucosa in the distal esophagus or esophagogastric junction. In the absence of type 3 pattern, one to 8 biopsies were targeted to areas with a type 2 pattern in columnar-appearing mucosa in the distal esophagus or esophagogastric junction. The overall frequency of intestinal metaplasia in the esophagus and esophagogastric junction was 38.8% (26/67 patients). There was a good correlation between the type 3 pattern and intestinal metaplasia in targeted biopsy specimens (sensitivity 88.5%, specificity 90.2%, positive predictive value 85.2%, negative predictive value 92.5%, overall accuracy 90.0%). Enhanced-magnification endoscopy is useful for detection of intestinal metaplasia in distal esophagus and esophagogastric junction.