Published online Nov 26, 2018. doi: 10.12998/wjcc.v6.i14.753
Peer-review started: July 13, 2018
First decision: July 24, 2018
Revised: September 4, 2018
Accepted: October 17, 2018
Article in press: October 16, 2018
Published online: November 26, 2018
To investigate the benefits of the Seattle protocol in the diagnosis of Chinese individuals with Barrett’s esophagus.
Subjects enrolled were patients from one center with endoscopically-suspected esophageal metaplasia. These patients first received narrow-band imaging-targeted biopsy, and later, the Seattle protocol-guided biopsy, within a period from October 2012 to December 2014. Those cases without initial pathologic patterns of intestinal metaplasia (IM) and then appearance or loss of IM tissue were designated as Group A or B, respectively. Those with initial pathologic patterns of IM, which then persisted or were lost were designated as Group C or D, respectively.
The number of cases for each group was as follows: A: 20, B: 78, C: 31 and D: 14. The distribution of the Prague criteria M levels of Group A was significantly higher than Group B (P = 0.174). Among these groups, Group C had the highest proportions of hiatus hernia (54.8%), long segment Barrett’s esophagus (29%), and also the highest Prague criteria M levels. The sensitivity of IM detection was 69.2% for the narrow-band imaging-targeted biopsy and 78.5% for the Seattle protocol-guided biopsy. The difference was not significant (P = 0.231). The number of detectable dysplasias increased from one case via the NBI-target biopsy to five cases via the Seattle protocol-guided biopsy, including one case of adenocarcinoma.
The Seattle protocol improved the IM detection in our subjects with higher Prague criteria M levels and disclosed more cases with dysplastic tissues.
Core tip: While comparing the diagnosis of Barrett’s esophagus in a Chinese population via narrow-band imaging-targeted biopsy or the Seattle protocol-guided biopsy, the sensitivity of intestinal metaplasia detection was 69.2% and 78.5%, respectively. The number of detectable dysplasias increased from one case via the narrow-band imaging-targeted biopsy to five cases via the Seattle protocol-guided biopsy. These results concluded that the Seattle protocol identified more cases with dysplastic tissues.