Adequacy of esophageal squamous mucosa specimens obtained during endoscopy: are standard biopsies sufficient for postablation surveillance in Barrett's esophagus? Journal Article

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Authors: Gupta, N; Mathur, S. C.; Dumot, J. A.; Singh, V; Gaddam, S; Wani, S. B.; Bansal, A; Rastogi, A; Goldblum, J. R.; Sharma, P
Article Title: Adequacy of esophageal squamous mucosa specimens obtained during endoscopy: are standard biopsies sufficient for postablation surveillance in Barrett's esophagus?
Abstract: BACKGROUND: After endoscopic eradication therapy (EET) for Barrett's esophagus (BE), surveillance of residual/recurrent intestinal metaplasia/dysplasia including subsquamous tissue is performed by using biopsy forceps. OBJECTIVE: The goal of this study was to compare the adequacy of biopsy specimens obtained from neo-squamous (post-EET patients) and native (non-BE patients) squamous mucosa. DESIGN: A case-control study using squamous biopsy specimens obtained at 2 tertiary referral centers was conducted. INTERVENTIONS: Two experienced GI pathologists reviewed specimens from patients with neo- (post-EET patients) and native (non-BE patients) squamous mucosa in a blinded fashion after developing standardized criteria to assess tissue depth. MAIN OUTCOME MEASUREMENTS: The primary outcome was the proportion of biopsy specimens that contained any amount of lamina propria. RESULTS: A total of 193 biopsy specimens (1692 tissue pieces) from 104 patients were reviewed: 163 neo- and 30 native squamous. Of all biopsy specimens, only 37% contained any amount of lamina propria, and, furthermore, fewer than 4% of specimens had sufficient lamina propria (ie, more than two thirds of the entire squamous tissue present). When examining individual squamous tissue pieces, fewer than 11% contained lamina propria. No statistically significant differences in the presence of lamina propria were detected between neo- and native squamous mucosa. CONCLUSION: The majority of esophageal squamous biopsy specimens obtained during endoscopy do not demonstrate lamina propria and subepithelial structures. This is true for both neo- and native squamous mucosa. Biopsy specimens of neo-squamous mucosa obtained after EET appear to be inadequate to exclude subsquamous intestinal metaplasia/dysplasia because lamina propria is not present in more than 60% of specimens. This has larger implications in the clinical management of BE patients after EET.
Journal Title: Gastrointestinal endoscopy
Volume: 75
Issue: 1
ISSN: 1097-6779; 0016-5107
Publisher: Mosby, Inc  
Journal Place: United States
Date Published: 2012
Start Page: 11
End Page: 18
Language: eng
DOI/URL:

10.1016/j.gie.2011.06.040
Notes: ID: 12393; CI: Copyright (c) 2012; JID: 0010505; CIN: Gastrointest Endosc. 2012 Jan;75(1):19-22. PMID: 22196808; 2011/04/14 [received]; 2011/06/27 [accepted]; 2011/09/10 [aheadofprint]; ppublish