Impact of Imprint Cytology in Detecting Short Segment Barrett's Esophagus

Background Short-segment Barrett's esophagus (SSBE) is defined by the presence of columnar-appearing mucosa in distal esophagus (involving less than 2 to 3 cm), with intestinal metaplasia on biopsy. Its potential to develop dysplasia and cancer may require a surveillance program with better diagnostic tools to detect intestinal metaplasia. Goals To investigate the role of imprint cytology as a diagnostic tool either alone or combined with histology in SSBE. Study Seventy-nine patients (46 men, 33 women) with SSBE diagnosed during elective upper gastroscopy were included. Patients with serrated z-line with short tongues of pink mucosa and patients with a circular nonserrated z-line that extended less than 2 cm above the esophagogastric junction were biopsied on four quadrants just distal to z-line. Four slides of imprint preparation (including 1, 2, 3, and 4 touching of each biopsy specimen) was made for cytologic examination. Hematoxylin and eosin and Alcian blue staining for histologic examinations and Alcian Blue for cytologic evaluations were used to find evidence of intestinal metaplasia. Results Intestinal metaplasia was detected in 15 (19%), 21 (27%), and 30 (38%) patients by histologic examination with hematoxylin and eosin alone, by Alcian blue alone, and by histologic plus cytologic examination with Alcian blue, respectively. Nine patients with negative histologic but positive cytologic results were positive for intestinal metaplasia when they were reevaluated after further sectioning and staining. Sensitivity of imprint cytology alone was 53%. When imprint cytology was combined with the histologic evaluation, the prevalence of intestinal metaplasia increased from 27% to 38% (p < 0.05). Conclusion Imprint cytology might be a complementary diagnostic tool for histology in detecting patients with SSBE.