Improved Routine Detection of Barrett's Esophagus

Abstract

The number of esophageal adenocarcinoma is growing in Europe. Despite numerous upper GI endoscopies, only few patients are diagnosed early on. As short Barrett's esophagus [BE] is now well known, this clinical condition is most probably diagnosed during routine endoscopic examinations. The aim of this study is to test a fixed magnification endoscope and its endoscopic possibilities for cardia examinations. Method: From February to October 2003, 153 examinations were performed with a prototype Olympus XGIF Q160 E, which has the usual technical features of a commercially available gastroscope plus a modifying lens that enables fixed magnification [magnification ×60], allowing for easier minute examination of digestive mucosa. Chromoscopy was carried out with 3 % acetic acid and the endoscopic diagnosis was confirmed by target biopsies. A plastic cap was used in order to maintain a close focus. Patients: 138 patients were referred for reflux symptoms; 15 patients were Barrett's esophagus follow-up patients. The use of a fixed magnification endoscope allowed for careful examination of the cardia area with: oesophageal squamous mucosa, Z-line, cardial mucosa with regular pattern spread from 2-5 mm, and then fundus mucosa. In 15 Barrett's esophagus patients: distorted pattern, hypervascularisation area, or enlarged grooves were seen. Compared to a usual magnification endoscope [magnification ×80 to 120], it was not possible to determine detailed patterns such as complete intestinal metaplasia or dysplasia. In 138 patients with reflux, we were able to diagnose Barrett's esophagus in 8 cases [3 short, 5 ultra-short]. The handling of a fixed magnification endoscope, with or without plastic cap, is less cumbersome than the usual magnification endoscope [Olympus GIF Q160 Z]. Conclusion: Short Barrett's esophagus is probably under diagnosis during routine endoscopy. Fixed magnification endoscope with acetic acid and chromoscopy increases the endoscopic yield. Examination of the cardia with magnification and chromoscopy should be performed routinely.