Abstract
Intestinal Metaplasia of the Gastric Cardia (IMC) is a frequent finding in patients undergoing upper endoscopy (UE). However, IMC is usually identify by biopsy of normal-appearing mucosa and its prevalence may be underestimated because of sampling error. Enhanced magnification endoscopy (EME),which combines the use of magnification endoscopy (ME) and acetic acid (AA) instillation, has been shown to improve surface mucosal visualization in Barrett`s esophagus. Aim: To evaluate the potential utility of EME to diagnose IMC. Methods: 72 patients undergoing elective UE underwent EME with an Olympus GIF-200Z (zoom 35X) and 1.5% AA instillation. Patients were included if the squamocolumnar junction and the esophagogastric junction were judged to be at the same level. AA surface patterns were characterized prior to AA-directed biopsy of suspected areas and correlated with histology. A pathologist blinded to the biopsy methods read each biopsy. Logistic regression was performed to determine if targeted biopsies of surface patterns could predict IMC. Results: EME detected 4 different endoscopic patterns. Pattern I: round pits, II: reticular, III: villous, and IV: ridged. Overall, EME identified IMC in 44 of the 72 patients, a prevalence of 61.1%. The sensitivity of detecting IMC by targeted biopsy in patterns I, II, III, and IV were 0/12 (0%), 8/58 (13.8%) odds ratio 2.16 (p=0.41), 72/78 (92.3%) odds ratio 12 (p=0.05), and 12/12 (100%) respectively. Conclusions: EME is an accurate method to detect intestinal metaplasia in the gastric cardia. EME is useful to target biopsies and thus avoid sampling error. IMC is a more frequent lesion than previously reported. Its clinical significance is uncertain and has to be established. Intestinal Metaplasia of the Gastric Cardia (IMC) is a frequent finding in patients undergoing upper endoscopy (UE). However, IMC is usually identify by biopsy of normal-appearing mucosa and its prevalence may be underestimated because of sampling error. Enhanced magnification endoscopy (EME),which combines the use of magnification endoscopy (ME) and acetic acid (AA) instillation, has been shown to improve surface mucosal visualization in Barrett`s esophagus. Aim: To evaluate the potential utility of EME to diagnose IMC. Methods: 72 patients undergoing elective UE underwent EME with an Olympus GIF-200Z (zoom 35X) and 1.5% AA instillation. Patients were included if the squamocolumnar junction and the esophagogastric junction were judged to be at the same level. AA surface patterns were characterized prior to AA-directed biopsy of suspected areas and correlated with histology. A pathologist blinded to the biopsy methods read each biopsy. Logistic regression was performed to determine if targeted biopsies of surface patterns could predict IMC. Results: EME detected 4 different endoscopic patterns. Pattern I: round pits, II: reticular, III: villous, and IV: ridged. Overall, EME identified IMC in 44 of the 72 patients, a prevalence of 61.1%. The sensitivity of detecting IMC by targeted biopsy in patterns I, II, III, and IV were 0/12 (0%), 8/58 (13.8%) odds ratio 2.16 (p=0.41), 72/78 (92.3%) odds ratio 12 (p=0.05), and 12/12 (100%) respectively. Conclusions: EME is an accurate method to detect intestinal metaplasia in the gastric cardia. EME is useful to target biopsies and thus avoid sampling error. IMC is a more frequent lesion than previously reported. Its clinical significance is uncertain and has to be established.
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