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First Level Endoscopy in Barrett’s Esophagus: Endoscopic Pictures, Praga Classification, and Biopsy Protocols

  • Massimo Conio
  • Antonella De Ceglie
  • Mattia Crespi
Chapter

Abstract

Barrett’s esophagus (BE) should only be diagnosed when there is a clearly endoscopically visible change from squamous to columnar epithelium in the distal esophagus, starting at gastro-esophageal junction.

During index endoscopy when BE is suspected or in known BE endoscopic surveillance, a careful inspection of the BE mucosa is recommended, using high-resolution endoscopes.

Endoscopic characteristic of the metaplastic epithelium must be described according to the Praga C&M criteria, reporting the site of the landmarks and the presence and location of visible lesions according to the Paris classification. The Seattle biopsy protocol and target biopsy samples from visible lesions are recommended at the time of diagnosis and at subsequent surveillance.

The development of advanced endoscopic imaging techniques that increase the detection of both intestinal metaplasia and dysplasia in BE has been the focus of intense research.

Keywords

Barrett’ esophagus Praga C&M criteria Seattle protocol High-resolution endoscopes Chromoendoscopy 

References

  1. 1.
    Shariff MK, Varghese S, O’Donovan M, et al. Pilot randomized crossover study comparing the efficacy of transnasal disposable endosheath with standard endoscopy to detect Barrett’s esophagus. Endoscopy. 2016;48:110–6.PubMedGoogle Scholar
  2. 2.
    Bennett C, Vakil N, Bergman J, et al. Consensus statements for management of Barrett’s dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process. Gastroenterology. 2012;143:336–46.CrossRefGoogle Scholar
  3. 3.
    Sharma P, Dent J, Armstrong D, Bergman JJ, et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology. 2006;131:1392–9.CrossRefGoogle Scholar
  4. 4.
    Aoki T, Hanyu N, Mukai H. Gastroesophageal reflux disease and Barrett’s esophagus: inspection in Japan. Sogo Rinsho. 2005;50:2005–8. (in Japanese).Google Scholar
  5. 5.
    Ishimura N, Amano Y, Kinoshita Y. Endoscopic definition of esophagogastric junction for diagnosis of Barrett’s esophagus: importance of systematic education and training. Dig Endosc. 2009;21:213–8.CrossRefGoogle Scholar
  6. 6.
    Schölvinck DW, Goto O, Seldenrijk CA, et al. Detection of palisade vessels as a landmark for Barrett’s esophagus in a western population. J Gastroenterol. 2016;5:682–90.CrossRefGoogle Scholar
  7. 7.
    Amano Y, Ishimura N, Furuta K, et al. Which landmark results in a more consistent diagnosis of Barrett’s esophagus, the gastric folds or the palisade vessels? Gastrointest Endosc. 2006;64:206–11.CrossRefGoogle Scholar
  8. 8.
    Tan WK, di Pietro M, Fitzgerald RC. Past, present and future of Barrett’s oesophagus. Eur J Surg Oncol. 2017;43:1148–60.CrossRefGoogle Scholar
  9. 9.
    Shaheen NJ, Falk GW, Iyer PG, Gerson LB, American College of Gastroenterology. ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol. 2016;11:30–50.CrossRefGoogle Scholar
  10. 10.
    Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014;63:7–42.CrossRefGoogle Scholar
  11. 11.
    Weusten B, Bisschops R, Coron E, et al. Endoscopic management of Barrett’s esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy. 2017;49:191–8.CrossRefGoogle Scholar
  12. 12.
    Conio M. Esophageal chromoendoscopy in Barrett’s esophagus: “cons”. Gastrointest Endosc. 2006;64:9–12.CrossRefGoogle Scholar
  13. 13.
    Paull A, Trier JS, Dalton MD, Camp RC, Loeb P, Goyal RK. The histologic spectrum of Barrett’s esophagus. N Engl J Med. 1976;295:476–80.CrossRefGoogle Scholar
  14. 14.
    Salimian KJ, Waters KM, Eze O, et al. Definition of barrett esophagus in the United States: support for retention of a requirement for goblet cells. Am J Surg Pathol. 2018;42(2):264–8.CrossRefGoogle Scholar
  15. 15.
    Bhat S, Coleman HG, Yousef F, et al. Risk of malignant progression in Barrett’s esophagus patients: results from a large population-based study. J Natl Cancer Inst. 2011;103:1049–57.CrossRefGoogle Scholar
  16. 16.
    Ishimura N, Amano Y, Appelman HD, et al. Barrett’s esophagus: endoscopic diagnosis. Ann N Y Acad Sci. 2011;1232:53–75.CrossRefGoogle Scholar
  17. 17.
    Dickman R, Levi Z, Vilkin A, Zvidi I, Niv Y. Predictors of specialized intestinal metaplasia in patients with an incidental irregular Z line. Eur J Gastroenterol Hepatol. 2010;22:135–8.CrossRefGoogle Scholar
  18. 18.
    Kim JB, Shin SR, Shin WG, et al. Prevalence of minimal change lesions in patients with non-erosive reflux disease: a case-control study. Digestion. 2012;85:288–94.CrossRefGoogle Scholar
  19. 19.
    Spechler SJ, Zeroogian JM, Antonioli DA, Wang HH, Goyal RK. Prevalence of metaplasia at the gastro-oesophageal junction. Lancet. 1994;344:1533–6.CrossRefGoogle Scholar
  20. 20.
    Chung CS, Lin CK, Liang CC, Hsu WF, Lee TH. Intentional examination of esophagus by narrow-band imaging endoscopy increases detection rate of cervical inlet patch. Dis Esophagus. 2015;28:666–72.CrossRefGoogle Scholar
  21. 21.
    Endoscopic Classification Review Group. Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy. 2005;37:570–8. Review.CrossRefGoogle Scholar
  22. 22.
    Epstein JA, Cosby H, Falk GW, Khashab MA, et al. Columnar islands in Barrett’s esophagus: do they impact Prague C&M criteria and dysplasia grade? J Gastroenterol Hepatol. 2017;32:1598–603.CrossRefGoogle Scholar
  23. 23.
    Vahabzadeh B, Seetharam AB, Cook MB, et al. Validation of the Prague C & M criteria for the endoscopic grading of Barrett’s esophagus by gastroenterology trainees: a multicenter study. Gastrointest Endosc. 2012;75:236–41.CrossRefGoogle Scholar
  24. 24.
    Eloubeidi M, Provenzale D. Does this patient have Barrett’s esophagus? The utility of predicting Barrett’s esophagus at the index endoscopy. Am J Gastroenterol. 1994;94:937–43.CrossRefGoogle Scholar
  25. 25.
    Levine DS, Blount PL, Rudolph RE, et al. Safety of a systematic endoscopic biopsy protocol in patients with Barrett’s esophagus. Am J Gastroenterol. 2000;95:1152–7.CrossRefGoogle Scholar
  26. 26.
    Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ. American Gastroenterological Association medical position statement on the management of Barrett’s esophagus. Gastroenterology. 2011;140:1084–91.CrossRefGoogle Scholar
  27. 27.
    Reid BJ, Blount PL, Feng Z, et al. Optimizing endoscopic biopsy detection of early cancers in Barrett’s high-grade dysplasia. Am J Gastroenterol. 2000;95:3089–96.CrossRefGoogle Scholar
  28. 28.
    Fitzgerald RC, Saeed IT, Khoo D, Farthing MJ, Burnham WR. Rigorous surveillance protocol increases detection of curable cancers associated with Barrett’s esophagus. Dig Dis Sci. 2001;46:1892–8.CrossRefGoogle Scholar
  29. 29.
    Kariv R, Plesec TP, Goldblum JR, et al. The Seattle protocol does not more reliably predict the detection of cancer at the time of esophagectomy than a less intensive surveillance protocol. Clin Gastroenterol Hepatol. 2009;7:653–8.CrossRefGoogle Scholar
  30. 30.
    Ishaq S, Harper E, Brown J, et al. Survey of current clinical practice in the diagnosis, management and surveillance of Barrett’s metaplasia: a UK national survey. Gut. 2003;53:A32.Google Scholar
  31. 31.
    Harrison R, Path FRC, Perr I, et al. Detection of intestinal metaplasia in Barrett’s esophagus: an observational comparator study suggests the need for a minimum of eight biopsies. Am J Gastroenterol. 2007;102:1154–61.CrossRefGoogle Scholar
  32. 32.
    Abela JE, Going JJ, Mackenzie JF, McKernan M, O’Mahoney S, Stuart RC. Systematic four-quadrant biopsy detects Barrett’s dysplasia in more patients than nonsystematic biopsy. Am J Gastroenterol. 2008;103:850–5.CrossRefGoogle Scholar
  33. 33.
    Pera M. Trends in incidence and prevalence of specialised intestinal metaplasia, Barrett’s esophagus and adenocarcinoma of the gastroesophageal junction. World J Surg. 2003;27:999–1008.CrossRefGoogle Scholar
  34. 34.
    Csendes A, Smok G, Burdiles P, et al. Prevalence of intestinal metaplasia according to the length of specialised columnar epithelium lining the distal esophagus in patients with gastroesophageal reflux. Dis Esophagus. 2003;16:24–8.CrossRefGoogle Scholar
  35. 35.
    Spechler SJ. Intestinal metaplasia at the gastroesophageal junction. Gastroenterology. 2004;126:567–75.CrossRefGoogle Scholar
  36. 36.
    Bibbò S, Ianiro G, Ricci R, et al. Barrett’s oesophagus and associated dysplasia are not equally distributed within the esophageal circumference. Dig Liver Dis. 2016;48:1043–7.CrossRefGoogle Scholar
  37. 37.
    Savarino E, Villanacci V. Barrett’s esophagus detection: multiple biopsies are useful, even better if you have an “X” on your map. Dig Liver Dis. 2016;48:1041–2.CrossRefGoogle Scholar
  38. 38.
    Khandwalla HE, Graham DY, Kramer JR, et al. Barrett’s esophagus suspected at endoscopy but no specialized intestinal metaplasia on biopsy, what’s next. Am J Gastroenterol. 2014;109:178–82.CrossRefGoogle Scholar
  39. 39.
    Srivastava A, Odze RD, Lauwers GY, Redston M, Antonioli DA, Glickman JN. Morphologic features are useful in distinguishing Barrett esophagus from carditis with intestinal metaplasia. Am J Surg Pathol. 2007;31:1733–41.CrossRefGoogle Scholar
  40. 40.
    Kara MA, Peters FP, Rosmolen WD, Krihnadath KK, ten Kate FJW, Fockens P, Bergman JJGHM. High-resolution endoscopy plus chromoendoscopy or narrow-band imaging in Barrett’s esophagus: a prospective randomized crossover study. Endoscopy. 2005;37:929–36.CrossRefGoogle Scholar
  41. 41.
    Elta GH, Wang KK. Enhanced endoscopic imaging. Preface. Gastrointest Endosc Clin N Am. 2009;19:xiii–xiv.CrossRefGoogle Scholar
  42. 42.
    Ngamruengphong S, Sharma VK, Das A. Diagnostic yield of methylene blue chromoendoscopy for detecting specialized intestinal metaplasia and dysplasia in Barrett’s esophagus: a meta-analysis. Gastrointest Endosc. 2009;69:1021–8.CrossRefGoogle Scholar
  43. 43.
    Olliver JR, Wild CP, Sahay P, et al. Chrmoendoscopy with methylene blue and associated DNA damage in Barrett’s oesophagus. Lancet. 2003;362:373–4.CrossRefGoogle Scholar
  44. 44.
    Sharma P, Marcon N, Wani S, et al. Non-biopsy detection of intestinal metaplasia and dysplasia in Barrett’s esophagus: a prospective multicenter study. Endoscopy. 2006;38:1206–12.CrossRefGoogle Scholar
  45. 45.
    Guelrud M, Herrera I, Essenfeld H, Castro J. Enhanced magnification endoscopy: a new technique to identify specialized intestinal metaplasia in Barrett’s esophagus. Gastrointest Endosc. 2001;53:559–65.CrossRefGoogle Scholar
  46. 46.
    Hoffman A, Kiesslich R, Bender A, et al. Acetic acid-guided biopsies after magnifying endoscopy compared with random biopsies in the detection of Barrett’s esophagus: a prospective randomized trial with crossover design. Gastrointest Endosc. 2006;64:1–8.CrossRefGoogle Scholar
  47. 47.
    Pech O, Petrone MC, Manner H, et al. One-step chromoendoscopy and structure enhancement using balsamic vinegar for screening of Barrett’s esophagus. Acta Gastroenterol Belg. 2008;71:243–5.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Coletta M, Sami SS, Nachiappan A, Fraquelli M, Casazza G, Ragunath K. Acetic acid chromoendoscopy for the diagnosis of early neoplasia and specialized intestinal metaplasia in Barrett’s esophagus: a meta-analysis. Gastrointest Endosc. 2016;83:57–67.CrossRefGoogle Scholar
  49. 49.
    ASGE Technology Committee, Thosani N, Abu Dayyeh BK, Sharma P, et al. ASGE Technology Committee systematic review and meta-analysis assessing the ASGE preservation and incorporation of valuable endoscopic innovations thresholds for adopting real-time imaging-assisted endoscopic targeted biopsy during endoscopic surveillance of Barrett’s esophagus. Gastrointest Endosc. 2016;83:684–98.CrossRefGoogle Scholar
  50. 50.
    Sharma P, Savides TJ, Canto MI, et al. ASGE Technology and Standards of Practice Committee. The American Society for Gastrointestinal Endoscopy PIVI (preservation and incorporation of valuable endoscopic innovations) on imaging in Barrett’s esophagus. Gastrointest Endosc. 2012;76:252–4.CrossRefGoogle Scholar
  51. 51.
    Bhandari P, Kandaswamy P, Cowlishaw D, Longcroft-Wheaton G. Acetic acid-enhanced chromoendoscopy is more cost-effective than protocol-guided biopsies in a high-risk Barrett’s population. Dis Esophagus. 2012;25:386–92.CrossRefGoogle Scholar
  52. 52.
    Kandiah K, Chedgy FJQ, Subramaniam S, et al. International development and validation of a classification system for the identification of Barrett’s neoplasia using acetic acid chromoendoscopy: the Portsmouth acetic acid classification (PREDICT). Gut. 2017.  https://doi.org/10.1136/gutjnl-2017-314512. pii: gutjnl-2017-314512 [Epub ahead of print] PubMed PMID: 28970288.
  53. 53.
    Meining A, Rosch T, Kiesslich R, et al. Inter- and intra-observer variability of magnification chromoendoscopy for detecting specialized intestinal metaplasia at the gastroesphageal junction. Endoscopy. 2004;36:160–4.CrossRefGoogle Scholar
  54. 54.
    Gupta N, Gaddam S, Wani SB, Bansal A, Rastogi A, Sharma P. Longer inspection time is associated with increased detection of high-grade dysplasia and esophageal adenocarcinoma in Barrett’s esophagus. Gastrointest Endosc. 2012;76:531–8.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Massimo Conio
    • 1
  • Antonella De Ceglie
    • 1
  • Mattia Crespi
    • 1
  1. 1.Department of GastroenterologyGeneral HospitalSanremoItaly

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