Usefulness of magnifying endoscopy with narrow band imaging for the detection of specialized intestinal metaplasia in columnar-lined esophagus and Barrett's adenocarcinoma.

BACKGROUND Barrett's esophagus with specialized intestinal metaplasia (SIM) from columnar-lined esophagus is difficult to distinguish with routine endoscopy. OBJECTIVE To examine the values of fine mucosal patterns and the capillary patterns observed by magnifying endoscopy with narrow band imaging (MENBI) for the detection of SIM in columnar-lined esophagus and superficial Barrett's adenocarcinoma. We also undertook a histologic investigation regarding whether the capillary pattern observed by MENBI corresponds to the 3-dimensional (3D) structure of the capillary as depicted by using a confocal laser-scanning microscope (CLSM). DESIGN To compare the findings of MENBI, at 217 sites of columnar-lined esophagus, with histologic findings. Capillaries of the superficial mucosal layer were observed and were analyzed by 3D with a CLSM in 45 biopsied specimens. PATIENTS Fifty-eight patients, including 4 with superficial Barrett's adenocarcinoma. SETTING Jikei University Hospital, Tokyo, Japan. RESULTS Upon observation, all 6 adenocarcinoma sites were classified as irregular patterns in both the fine mucosal patterns and capillary patterns. The most characteristic endoscopic patterns of SIM were revealed to be the cerebriform fine mucosal pattern (sensitivity, 56%; specificity, 79%; odds ratio, 4.78) and ivy- or deoxyribonucleic acid (DNA)-like capillary pattern (sensitivity, 77%; specificity, 94%; odds ratio, 51.6). The addition of capillary patterns to fine mucosal patterns improved the accuracy of diagnosing SIM (P < .0001). CONCLUSIONS MENBI was able to precisely visualize the structure of capillaries in the superficial mucosal layer. The addition of capillary patterns to fine mucosal patterns appeared to improve the diagnostic value for detecting SIM and superficial Barrett's adenocarcinoma upon observation by MENBI.

[1]  E. Jaramillo,et al.  Detection of intestinal metaplasia in distal esophagus and esophagogastric junction by enhanced-magnification endoscopy. , 2004, Gastrointestinal endoscopy.

[2]  M. Guelrud,et al.  Enhanced magnification endoscopy: a new technique to identify specialized intestinal metaplasia in Barrett's esophagus. , 2000, Gastrointestinal endoscopy.

[3]  Masahiro Yamaguchi,et al.  Endoscopic Observation of Tissue by Narrowband Illumination , 2003 .

[4]  S. Ishihara,et al.  Influence of Helicobacter pylori infection on the prevalence of reflux esophagitis in Japanese patients , 2001, Journal of gastroenterology and hepatology.

[5]  J. Fraumeni,et al.  Changing patterns in the incidence of esophageal and gastric carcinoma in the United States , 1998, Cancer.

[6]  S. Kudo,et al.  Narrow-band imaging system with magnifying endoscopy for superficial esophageal lesions. , 2004, Gastrointestinal endoscopy.

[7]  D. Levine.  Management of dysplasia in the columnar-lined esophagus. , 1997, Gastroenterology clinics of North America.

[8]  H. Tajiri,et al.  Magnifying Endoscopy Combined with Narrow Band Imaging System for Early Gastric Cancer: Correlation of Vascular Pattern with Histopathology (including video) , 2004, Endoscopy.

[9]  J. G. van den Tweel,et al.  Barrett's esophagus: development of dysplasia and adenocarcinoma. , 1989, Gastroenterology.

[10]  N. Powe,et al.  Methylene blue-directed biopsies improve detection of intestinal metaplasia and dysplasia in Barrett's esophagus. , 2000, Gastrointestinal endoscopy.

[11]  Yasushi Sano,et al.  Squamous cell carcinoma in situ at oropharyngeal and hypopharyngeal mucosal sites , 2004, Cancer.

[12]  C. Lightdale,et al.  Combined magnification endoscopy with chromoendoscopy for the evaluation of Barrett's esophagus. , 1994, Gastrointestinal endoscopy.

[13]  J. Olliver,et al.  Chromoendoscopy with methylene blue and associated DNA damage in Barrett's oesophagus , 2003, The Lancet.

[14]  N. Wright.  Morson and Dawson’s Gastrointestinal Pathology, 4th edn , 2005 .

[15]  R. Sampliner,et al.  Practice guidelines on the diagnosis, surveillance, and therapy of Barrett's esophagus , 1998, American Journal of Gastroenterology.

[16]  J. Rahamim,et al.  Oesophagogastrectomy for carcinoma of the oesophagus and cardia , 1993, The British journal of surgery.

[17]  Hiroyuki Yamamoto,et al.  Classification of Barrett's epithelium by magnifying endoscopy. , 2002, Gastrointestinal endoscopy.

[18]  R. Goyal,et al.  The histologic spectrum of Barrett's esophagus. , 1976, The New England journal of medicine.

[19]  M. Hongo,et al.  Epidemiology of reflux disease and CLE in East Asia. , 2002, Journal of gastroenterology.

[20]  Kohzoh Imai,et al.  Usefulness of narrow-band imaging endoscopy for diagnosis of Barrett’s esophagus , 2003, Journal of Gastroenterology.

[21]  S. McClave,et al.  Early diagnosis of columnar-lined esophagus: a new endoscopic diagnostic criterion. , 1987, Gastrointestinal endoscopy.

[22]  A. Blum,et al.  Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification , 1999, Gut.

[23]  A. Bhattacharyya,et al.  Magnification chromoendoscopy for the detection of intestinal metaplasia and dysplasia in Barrett’s oesophagus , 2003, Gut.