Case Control Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2018; 6(14): 753-758
Published online Nov 26, 2018. doi: 10.12998/wjcc.v6.i14.753
Benefits of the Seattle biopsy protocol in the diagnosis of Barrett’s esophagus in a Chinese population
Shou-Wu Lee, Han-Chung Lien, Chi-Sen Chang, Ming-Xian Lin, Chung-Hsin Chang, Chung-Wang Ko
Shou-Wu Lee, Han-Chung Lien, Chi-Sen Chang, Ming-Xian Lin, Chung-Hsin Chang, Chung-Wang Ko, Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
Shou-Wu Lee, Chi-Sen Chang, Department of Internal Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
Han-Chung Lien, Chung-Wang Ko, Department of Internal Medicine, National Yang-Ming University, Taipei 11221, Taiwan
Author contributions: Lee SW and Lien HC contributed equally to this work; Lee SW, Lien HC, Chang CS and Lin MX designed the research; Lee SW, Lien HC, Lin MX, Chang CH and Ko CW performed the research; Lee SW contributed analytic tools; Lee SW and Chang CH analyzed the data; Lee SW and Lien HC wrote the paper.
Institutional review board statement: This study was reviewed and approved by the Taichung Veteran General Hospital Institutional Review Board Committee.
Informed consent statement: Patients were required to give informed consent, and clinical data were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shou-Wu Lee, MD, PhD, Assistant Professor, Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung 40705, Taiwan. ericest@vghtc.gov.tw
Telephone: +886-4-23592525-3306 Fax: +886-4-23595046
Received: July 13, 2018
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
ARTICLE HIGHLIGHTS
Research background

According to the American Gastroenterological Association guidelines, the definition of Barrett’s esophagus (BE) includes the histological finding of intestinal metaplasia (IM) in the esophagus. BE is clinically important because it is a major risk factor for the development of esophageal malignancy. Therefore, early detection of BE, especially those with dysplastic tissue, attracted recent research interests.

Research motivation

The standard for diagnosing BE is endoscopic evaluation performed with the Seattle biopsy protocol. However, some in this field consider disadvantages of the Seattle protocol as being relatively inefficient, time-consuming and providing low diagnostic rates. In Western countries, reportedly only half of endoscopists follow the Seattle protocol for biopsy of BE patients.

Research objectives

The aim of this study is to investigate the benefits of the Seattle protocol in the diagnosis of Chinese individuals with BE.

Research methods

Subjects enrolled were cases of Taichung Veterans General Hospital with endoscopically-suspected esophageal metaplasia. These patients first received the narrow-band imaging (NBI)-targeted biopsy and later the Seattle protocol-guided biopsy, within a period from October 2012 to December 2014. Cases without initial pathologic patterns of 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.

Research results

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). The sensitivity of IM detection was 69.2% for the NBI-targeted biopsy and 78.5% for the Seattle protocol-guided biopsy. The difference was not significant (P = 0.231). The number of detectable dysplasia increased from one case via the NBI-targeted biopsy to five cases via the Seattle protocol-guided biopsy, including one case of adenocarcinoma.

Research conclusions

The Seattle protocol improved the IM detection in the subjects with higher Prague criteria M levels, and it disclosed more cases with dysplastic tissues.

Research perspectives

In the future, the prospective studies in the selected BE patients should be conducted to evaluate the usefulness of the Seattle protocol in clinical practice.