Abstract
Barrett’s esophagus is the only known pre-cancerous lesion for esophageal adenocarcinoma and is diagnosed by high-definition white light endoscopy demonstrating a columnar-lined esophagus along with biopsy evidence of intestinal metaplasia. With accurate performance and reporting of the endoscopic procedure, an evidence-based management strategy can be developed for treatment of Barrett’s dysplasia. However, cross-sectional data demonstrate that there is still inconsistency among gastroenterologists in performance and reporting of endoscopic findings in patients with Barrett’s esophagus. Here, we present an evidence-based review of how to report endoscopic findings in Barrett’s esophagus.
Similar content being viewed by others
References
Sharma P. Barrett’s esophagus. N Engl J Med. 2009;361:2548–2556.
Shaheen NJ, Falk GW, Iyer PG, Gerson LB. ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol. 2016;111:30–50. (quiz 51).
Skinner DB, Walther BC, Riddell RH, Schmidt HE, Lascone C, Demeester TR. Barrett’s esophagus. Comparison of benign and malignant cases. Ann Surg. 1983;198:554–565.
Spechler SJ, Zeroogian JM, Antonioli DA, Wang HH, Goyal RK, et al. Prevalence of metaplasia at the gastro-oesophageal junction. Lancet. 1994;344:1533–1536.
Jung KW, Talley NJ, Romero Y, et al. Epidemiology and natural history of intestinal metaplasia of the gastroesophageal junction and Barrett’s esophagus: a population-based study. Am J Gastroenterol. 2011;106:1447–1455. (quiz 1456).
Sikkema M, Looman CW, Steyerberg EW, et al. Predictors for neoplastic progression in patients with Barrett’s esophagus: a prospective cohort study. Am J Gastroenterol. 2011;106:1231–1238.
Coleman HG, Bhat SK, Murray LJ, et al. Symptoms and endoscopic features at Barrett’s esophagus diagnosis: implications for neoplastic progression risk. Am J Gastroenterol. 2014;109:527–534.
Buttar NS, Wang KK, Sebo TJ, et al. Extent of high-grade dysplasia in Barrett’s esophagus correlates with risk of adenocarcinoma. Gastroenterology. 2001;120:1630–1639.
Montgomery E, Bronner MP, Greenson JK, et al. Are ulcers a marker for invasive carcinoma in Barrett’s esophagus? Data from a diagnostic variability study with clinical follow-up. Am J Gastroenterol. 2002;97:27–31.
Peters FP, Brakenhoff KP, Curvers WL, et al. Histologic evaluation of resection specimens obtained at 293 endoscopic resections in Barrett’s esophagus. Gastrointest Endosc. 2008;67:604–609.
Tharavej C, Hagen JA, Peters JH, et al. Predictive factors of coexisting cancer in Barrett’s high-grade dysplasia. Surg Endosc. 2006;20:439–443.
Sharma N, Srivastava S, Kern F, et al. Endoscopic modalities for the diagnosis of Barrett’s oesophagus. United European Gastroenterol J. 2016;4:733–740.
Brown J, Sharma P. From Prague to Seattle: improved endoscopic technique and reporting improves outcomes in patients with Barrett’s esophagus. Dig Dis Sci. 2016;61:4–5.
Visrodia K, Iyer PG, Schleck CD, et al. Yield of repeat endoscopy in Barrett’s esophagus with no dysplasia and low-grade dysplasia: a population-based study. Dig Dis Sci. 2016;61:158–167.
Singh M, Gupta N, Gaddam S, et al. Practice patterns among U.S. gastroenterologists regarding endoscopic management of Barrett’s esophagus. Gastrointest Endosc. 2013;78:689–695.
Kwon RS, Adler DG, Chand B, et al. High-resolution and high-magnification endoscopes. Gastrointest Endosc. 2009;69:399–407.
Canto MI, Anandasabapathy S, Brugge W, et al. In vivo endomicroscopy improves detection of Barrett’s esophagus-related neoplasia: a multicenter international randomized controlled trial (with video). Gastrointest Endosc. 2014;79:211–221.
Sharma P, Hawes RH, Bansal A, et al. Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett’s oesophagus: a prospective, international, randomised controlled trial. Gut. 2013;62:15–21.
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.
Spechler SJ, Sharma P, Souza RF, et al. American Gastroenterological Association technical review on the management of Barrett’s esophagus. Gastroenterology. 2011;140:e18-52. (quiz e13).
Boyce HW. Endoscopic definitions of esophagogastric junction regional anatomy. Gastrointest Endosc. 2000;51:586–592.
Choi DW, Baek SJ, Ahn SH, et al. Endoscopically observed lower esophageal capillary patterns. Korean J Intern Med. 2002;17:245–248.
American Gastroenterological Association. American Gastroenterological Association medical position statement on the management of Barrett’s esophagus. Gastroenterology. 2011;140:1084–1091.
Wallner B. Endoscopically defined gastroesophageal junction coincides with the anatomical gastroesophageal junction. Surg Endosc. 2009;23:2155–2158.
Ogiya K, Kawano T, Ito E, et al. Lower esophageal palisade vessels and the definition of Barrett’s esophagus. Dis Esophagus. 2008;21:645–649.
Andrici J, Tio M, Cox MR, et al. Hiatal hernia and the risk of Barrett’s esophagus. J Gastroenterol Hepatol. 2013;28:415–431.
Johnson DA, Younes Z, Hogan WJ. Endoscopic assessment of hiatal hernia repair. Gastrointest Endosc. 2000;52:650–659.
Kahrilas PJ, Kim HC, Pandolfino JE. Approaches to the diagnosis and grading of hiatal hernia. Best Pract Res Clin Gastroenterol. 2008;22:601–616.
Weusten B, Bisschops R, Coron E, et al. Endoscopic management of Barrett’s esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy. 2017;49:191–198.
Gopal DV, Lieberman DA, Magaret N, et al. Risk factors for dysplasia in patients with Barrett’s esophagus (BE): results from a multicenter consortium. Dig Dis Sci. 2003;48:1537–1541.
Menke-Pluymers MB, Hop WC, Dees J, et al. Risk factors for the development of an adenocarcinoma in columnar-lined (Barrett) esophagus. The Rotterdam Esophageal Tumor Study Group. Cancer. 1993;72:1155–1158.
Anaparthy R, Gaddam S, Kanakadandi V, et al. Association between length of Barrett’s esophagus and risk of high-grade dysplasia or adenocarcinoma in patients without dysplasia. Clin Gastroenterol Hepatol. 2013;11:1430–1436.
Sharma P, Morales TG, Bhattacharyya A, Garewal HS, Sampliner RE. Dysplasia in short-segment Barrett’s esophagus: a prospective 3-year follow-up. Am J Gastroenterol. 1997;92:2012–2016.
Weston AP, Krmpotich PT, Cherian R, Dixon A, Topalosvki M. Prospective long-term endoscopic and histological follow-up of short segment Barrett’s esophagus: comparison with traditional long segment Barrett’s esophagus. Am J Gastroenterol. 1997;92:407–413.
Conio M, Aste H, Bonelli L. “Short” Barrett’s esophagus: a condition not to be underestimated. Gastrointest Endosc. 1994;40:111.
Sharma P, Dent J, Armstrong D, et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology. 2006;131:1392–1399.
Alvarez Herrero L, Curvers WL, Van Vilsteren FG, et al. Validation of the Prague C&M classification of Barrett’s esophagus in clinical practice. Endoscopy. 2013;45:876–882.
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;75:236–241.
Chang CY, Lee YC, Lee CT, et al. The application of Prague C and M criteria in the diagnosis of Barrett’s esophagus in an ethnic Chinese population. Am J Gastroenterol. 2009;104:13–20.
Lee YC, Cook MB, Bhatia S, et al. Interobserver reliability in the endoscopic diagnosis and grading of Barrett’s esophagus: an Asian multi-national study. Endoscopy. 2010;42:699–704.
Gupta N, Gaddam S, Wani SB, et al. Longer inspection time is associated with increased detection of high-grade dysplasia and esophageal adenocarcinoma in Barrett’s esophagus. Gastrointest Endosc. 2012;76:531–538.
Bisschops R, Areia M, Coron E, et al. Performance measures for upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy quality improvement initiative. United European Gastroenterol J. 2016;4:629–656.
Enestvedt BK, Lugo R, Guarner-Argente C, et al. Location, location, location: does early cancer in Barrett’s esophagus have a preference? Gastrointest Endosc. 2013;78:462–467.
Kariyawasam VC, Bourke MJ, Hourigan LF, et al. Circumferential location predicts the risk of high-grade dysplasia and early adenocarcinoma in short-segment Barrett’s esophagus. Gastrointest Endosc. 2012;75:938–944.
Cassani L, Sumner E, Slaughter JC, et al. Directional distribution of neoplasia in Barrett’s esophagus is not influenced by distance from the gastroesophageal junction. Gastrointest Endosc. 2013;77:877–882.
Axon A, Diebold MD, Fujino M, et al. Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy. 2005;37:570–578.
Prasad GA, Bansal A, Sharma P, et al. Predictors of progression in Barrett’s esophagus: current knowledge and future directions. Am J Gastroenterol. 2010;105:1490–1502.
Pech O, Gossner L, Manner H, et al. Prospective evaluation of the macroscopic types and location of early Barrett’s neoplasia in 380 lesions. Endoscopy. 2007;39:588–593.
Abela JE, Going JJ, Mackenzie JF, et al. Systematic four-quadrant biopsy detects Barrett’s dysplasia in more patients than nonsystematic biopsy. Am J Gastroenterol. 2008;103:850–855.
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;95:1152–1157.
Boerwinkel DF, Swager AF, Curvers WL, Bergman JJ. The clinical consequences of advanced imaging techniques in Barrett’s esophagus. Gastroenterology. 2014;146:622–629.
Gill RS, Singh R. Endoscopic imaging in Barrett’s esophagus: current practice and future applications. Ann Gastroenterol. 2012;25:89–95.
Wolfsen HC, Sharma P, Wallace MB, et al. Safety and feasibility of volumetric laser endomicroscopy in patients with Barrett’s esophagus (with videos). Gastrointest Endosc. 2015;82:631–640.
ASGE Technology Committee, Dayyeh BK, Thosani N, 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;83:684–698.
Sharma P, Brill J, Canto M, et al. White paper AGA: advanced imaging in Barrett’s esophagus. Clin Gastroenterol Hepatol. 2015;13:2209–2218.
Chedgy FJQ, Subramaniam S, Kandiah K, et al. Acetic acid chromoendoscopy: improving neoplasia detection in Barrett’s esophagus. World J Gastroenterol. 2016;22:5753–5760.
Reaud S, Croue A, Boyer J. Diagnostic accuracy of magnifying chromoendoscopy with detection of intestinal metaplasia and dysplasia using acetic acid in Barrett’s esophagus. Gastroenterol Clin Biol. 2006;30:217–223.
Mayinger B, Oezturk Y, Stolte M, et al. Evaluation of sensitivity and inter- and intra-observer variability in the detection of intestinal metaplasia and dysplasia in Barrett’s esophagus with enhanced magnification endoscopy. Scand J Gastroenterol. 2006;41:349–356.
Yagi K, Nakamura A, Sekine A, et al. Endoscopic diagnosis of mucosal adenocarcinomas and intestinal metaplasia of columnar-lined esophagus using enhanced-magnification endoscopy. Dig Endosc. 2006;18:S21–S26.
Fortun PJ, Anagnostopoulos GK, Kaye P, et al. Acetic acid-enhanced magnification endoscopy in the diagnosis of specialized intestinal metaplasia, dysplasia and early cancer in Barrett’s oesophagus. Aliment Pharmacol Ther. 2006;23:735–742.
Bhandari P, Kandaswamy P, Cowlishaw D, et al. Acetic acid-enhanced chromoendoscopy is more cost-effective than protocol-guided biopsies in a high-risk Barrett’s population. Dis Esophagus. 2012;25:386–392.
Longcroft–Wheaton G, Duku M, Mead R, et al. Acetic acid spray is an effective tool for the endoscopic detection of neoplasia in patients with Barrett’s esophagus. Clin Gastroenterol Hepatol. 2010;8:843–847.
Pohl J, May A, Rabenstein T, et al. Comparison of computed virtual chromoendoscopy and conventional chromoendoscopy with acetic acid for detection of neoplasia in Barrett’s esophagus. Endoscopy. 2007;39:594–598.
Vazquez-Iglesias JL, Alonso-Aguirre P, Diz-Lois MT, et al. Acetic acid allows effective selection of areas for obtaining biopsy samples in Barrett’s esophagus. Eur J Gastroenterol Hepatol. 2007;19:187–193.
Pohl J, Pech O, May A, et al. Incidence of macroscopically occult neoplasias in Barrett’s esophagus: are random biopsies dispensable in the era of advanced endoscopic imaging? Am J Gastroenterol. 2010;105:2350–2356.
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.
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.
Wani S, Sharma P. Narrow band imaging in Barrett’s esophagus. Expert Rev Gastroenterol Hepatol. 2007;1:53–60.
Wolfsen HC, Crook JE, Krishna M, et al. Prospective, controlled tandem endoscopy study of narrow band imaging for dysplasia detection in Barrett’s Esophagus. Gastroenterology. 2008;135:24–31.
Sharma P, Bergman JJ, Goda K, et al. Development and validation of a classification system to identify high-grade dysplasia and esophageal adenocarcinoma in Barrett’s esophagus using narrow-band imaging. Gastroenterology. 2016;150:591–598.
Conflict of interest
The authors have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gorrepati, V.S., Sharma, P. How Should We Report Endoscopic Results in Patient’s with Barrett’s Esophagus?. Dig Dis Sci 63, 2115–2121 (2018). https://doi.org/10.1007/s10620-018-5067-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-018-5067-7