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Magnification endoscopy for detection of specialized intestinal metaplasia at the esophagogastric junction


, : Magnification endoscopy for detection of specialized intestinal metaplasia at the esophagogastric junction. Digestive Disease Week Abstracts & Itinerary Planner : Abstract No 577

Background: It has been reported by Endo et al. and Guelrud et al. (Gastrointest Endoscopy 2001) that magnification endoscopy for classification of the appearance of the mucosa helps to differentiate between the gastric and intestinal phenotype. Thereby, the insufficiencies of current surveillance strategies might be reduced for identification and selection of patients with short segments of Barretts esophagus. Methods: A total of 41 patients with reflux symptoms and no known Barretts esophagi were investigated with a magnification endoscope (GIF Q160Z, Olympus GmbH, Hamburg, Germany). Methylen-blue staining was performed in 20 patients to enable pit-pattern classification according to the criteria of Endo et al. In the remaining 21 patients, 1.5% acetic acid was sprayed onto the distal esophagus to enable pattern classification as suggested by Guelrud et al. Video-sequences of the gastro-esophageal junction were recorded at 4 quadrants starting at 12 o clock. Thereafter, biopsies were taken from the same areas. The video tapes were analyzed for pit-patterns in accordance with the respective method. For each patient the highest extend of pit patterns in one or more of the 4 quadrants was noted. Results: Specialized intestinal metaplasia was detected at the esophagogastric junction in 58.5% (24/41 patients) in targeted biopsy samples. With respect to the classification of Endo et al. the presence of SIM in relation to the pit pattern was 1/1 patient for pit I, 0/0 for pit II, 3/8 for pit III, 4/9 for pit IV, and 2/2 for pit V. For the classification of Guelrud et al., SIM was found in 0/0 patients for pit I, 1/1 for pit II, 5/8 for pit III, and 8/12 for pit IV. When the pit patterns were grouped into 2 major classes (pit IV and V vs. pit I to III according to Endo, and pit III and IV vs. pit I and II according to Guelrud), the accuracy rates to detect SIM were 55.0% and 61.9%, respectively. Conclusion: So far, our own experience shows that although magnifying endoscopy may improve the yield of detecting SIM at the esophagogastric junction, its accuracy is still rather low.

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