Original Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 7, 2013; 19(41): 7089-7096
Published online Nov 7, 2013. doi: 10.3748/wjg.v19.i41.7089
Magnifying endoscopy for the diagnosis of specialized intestinal metaplasia in short-segment Barrett’s esophagus
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, So Young Jin, Ji Sung Lee
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
So Young Jin, Department of Pathology, Soonchunhyang University Hospital, Seoul 140-743, South Korea
Ji Sung Lee, Biostatistical Consulting Unit, Soonchunhyang University Hospital, Seoul 140-743, South Korea
Author contributions: Ham NS and Jang JY performed the majority of study; Jang JY performed the magnifying endoscopy and methylene blue chromoendoscopy and analyzed the results of the endoscopic examination; Ham NS collected the data and drafted the paper; Ryu SW, Kim JH, Park EJ, Lee WC and Shim KY organized the patients’ data; Jeong SW, Kim HG, Lee TH, Jeon SR, Cho JH and Cho JY consulted for our study; Jin SY analyzed the biopsies; and Lee JS helped with the statistical analysis.
Correspondence to: Jae Young Jang, MD, Institution for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University Hospital, 657 Hannam-dong, Yongsan-gu, Seoul 140-743, South Korea. jyjang@schmc.ac.kr
Telephone: +82-2-7099027 Fax: +82-2-7099696
Received: May 12, 2013
Revised: August 10, 2013
Accepted: September 13, 2013
Published online: November 7, 2013
Processing time: 188 Days and 9.3 Hours
Abstract

AIM: 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).

CONCLUSION: The magnified observation of a short-segment BE according to the mucosal pattern and its classification can be predictive of SIM.

Keywords: Short-segment; Barrett’s esophagus; Magnifying endoscopy; Methylene blue chromoendoscopy; Specialized intestinal metaplasia; Dysplasia; Esophageal adenocarcinoma; Diagnosis

Core tip: Various endoscopic approaches and advancements have shown great promise. However, careful endoscopic observation and stepwise four quadrant biopsy still represent the standard for the surveillance of Barrett’s esophagus (BE). In our study, we investigated the usefulness of magnifying endoscopy for the diagnosis of specialized intestinal metaplasia (SIM) in patients with short-segment BE compared with methylene blue chromoendoscopy. We found that the magnified observation of a short-segment BE according to its mucosal pattern and classification can be predictive of SIM.