The magnified endoscopic view of cardia-type mucosa.

Abstract

The interpretation of magnification endoscopy regarding metaplasia of the esophagogastric junction (EGJ) is still controversial. Histology of areas endoscopically suspected of Barrett's esophagus often reveals only cardia-type mucosa (CTM). The aim of this study was to characterize the surface structure of CTM by magnification endoscopy, in comparison with specialized intestinal metaplasia (SIM) and gastric corpus mucosa. Magnification endoscopy was performed in 52 patients with normal EGJ and 36 patients with columnar lined lower esophagus (CLE) on endoscopic examination. Biopsies for histology were obtained from EGJ and CLE segments. In cases with CLE, biopsies were targeted after methylene blue staining. A gyriform or oval pattern was observed in all patients at the normal EGJ, histologically representing CTM. These patterns of CTM were easily discernible from the small pits of corpus mucosa. A gyriform or villous pattern was dominant in CLE, both in areas with CTM and those with SIM. Methylene blue staining was more frequent in SIM than in CTM, but was of insufficient specificity for SIM. Although magnification endoscopy allows one to differentiate CTM from gastric corpus mucosa, a clear distinction from SIM is not possible. Auxiliary methods that complement magnification endoscopy, like methylene blue staining and acetic acid contrast enhancement, should be evaluated regarding the differentiation between CTM and SIM.