Acetic acid-enhanced magnification endoscopy in the diagnosis of specialized intestinal metaplasia, dysplasia and early cancer in Barrett's oesophagus
Article first published online: 27 FEB 2006
Alimentary Pharmacology & Therapeutics
Volume 23, Issue 6, pages 735–742, March 2006
How to Cite
FORTUN, P. J., ANAGNOSTOPOULOS, G. K., KAYE, P., JAMES, M., FOLEY, S., SAMUEL, S., SHONDE, A., BADRELDIN, R., CAMPBELL, E., HAWKEY, C. J. and RAGUNATH, K. (2006), Acetic acid-enhanced magnification endoscopy in the diagnosis of specialized intestinal metaplasia, dysplasia and early cancer in Barrett's oesophagus. Alimentary Pharmacology & Therapeutics, 23: 735–742. doi: 10.1111/j.1365-2036.2006.02823.x
- Issue published online: 27 FEB 2006
- Article first published online: 27 FEB 2006
- Publication data Submitted 25 November 2005 First decision 20 December 2005 Resubmitted 27 December 2005 Accepted 27 December 2005
Barrett's surveillance is prone to sampling error.
To determine whether enhanced magnification endoscopy using acetic acid instillation improves diagnostic accuracy of specialized intestinal metaplasia/dysplasia in Barrett's oesophagus.
We examined the detection rate of the specialized intestinal metaplasia/dysplasia in 64 consecutive patients with Barrett's oesophagus using acetic acid to enhance mucosal pit patterns. Histology was compared with the previous findings at recent conventional surveillance in 62 patients. We also examined the inter-/intra-observer agreement in the assessment of the enhanced magnification endoscopy pit pattern findings.
Histology revealed columnar-lined oesophagus in six (9%) patients, specialized intestinal metaplasia in 49 (77%), low-grade dysplasia in five (8%), high-grade dysplasia in one (2%), and adenocarcinoma in three (5%). There was discordance between the histologic findings from conventional surveillance with random biopsy. Fifteen patients (24%) had a histological upgrade with enhanced magnification endoscopy. There was a high detection rate of specialized intestinal metaplasia even in short segment Barrett's oesophagus (74%), and additionally, there were two cancers, one with 2-cm Barrett's oesophagus and one ultra-short (1 cm). The mean kappa values for inter- and intra-observer agreement in assessing the pit patterns were 0.571 (0.041) and 0.709 (0.038), respectively.
Enhanced magnification endoscopy allows clear visualization of the epithelial pit patterns within Barrett's oesophagus, and targeted biopsy results in a high yield of specialized intestinal metaplasia and dysplasia.