Prevalence of Barrett's Epithelium Shown by Endoscopic Observations with Linked Color Imaging in Subjects with Different <i>H. pylori</i> Infection Statuses

Abstract

Objective This study was conducted to clarify the prevalence of short segment Barrett's esophagus (SSBE) using endoscopic observations with linked color imaging (LCI). In addition, the relationship between the presence of Barrett's epithelium (BE) and the status of H. pylori infection was investigated. Methods The study subjects were 3,353 individuals (2,186 men, 1,167 women; mean age 55.2±9.4 years old) whose status of H. pylori infection had been determined. An endoscopic observation using LCI was performed to examine the distal margin of palisade vessels and confirm the area of BE. The prevalence of BE ≥5 mm in length was investigated. Results BE was diagnosed in 1,884 (56.2%) subjects, with lengths of <10, 10-19, 20-29, and ≥30 mm found in 1,005, 851, 27, and 1, respectively. Its prevalence in H. pylori -negative, H. pylori -positive, and post-eradicated subjects was 41.7%, 64.4%, and 69.9%, respectively (p<0.001). The duration since successful eradication of H. pylori did not affect the prevalence of BE. The degree of gastric mucosal atrophy was higher in cases with BE (p<0.001), although negativity for H. pylori infection and mild gastric mucosal atrophy were significant factors for the development of longer BE. Conclusion A high prevalence of SSBE was noted when LCI was used to determine the area of BE, as the distal end of the palisade vessels was easily visualized. Negativity for H. pylori infection and mild gastric mucosal atrophy were not correlated with SSBE prevalence.

Low risk of esophageal adenocarcinoma among patients with ultrashort‐segment Barrett's esophagus in Japan

“…In this large, retrospective cohort study comprising healthy participants who underwent screening endoscopy, we found that the prevalence of USSBE at enrollment was quite high (36.4%), which is consistent with previous reports in Japan 6–11 . Importantly, we found that the incidence of EAC in USSBE was very low (0.0068%/year; nearly as low as the incidence of GC in subjects with atrophy‐free stomach [0.0059%/year]).…”

“…I N THIS LARGE, retrospective cohort study comprising healthy participants who underwent screening endoscopy, we found that the prevalence of USSBE at enrollment was quite high (36.4%), which is consistent with previous reports in Japan. [6][7][8][9][10][11] Importantly, we found that the incidence of EAC in USSBE was very low (0.0068%/year; nearly as low as the incidence of GC in subjects with atrophy-free stomach [0.0059%/year]). Although this was a retrospective study, it is the first to show concrete incidence of EAC in USSBE defined by Japanese criteria, and the outcomes will greatly influence the current clinical practice, as a huge number (15-80%) of Japanese subjects undergoing EGD are being diagnosed with USSBE.…”

“…Importantly, we found that the incidence of EAC in USSBE was very low (0.0068%/year; nearly as low as the incidence of GC in subjects with atrophy‐free stomach [0.0059%/year]). Although this was a retrospective study, it is the first to show concrete incidence of EAC in USSBE defined by Japanese criteria, and the outcomes will greatly influence the current clinical practice, as a huge number (15–80%) of Japanese subjects undergoing EGD are being diagnosed with USSBE 6–11 …”

“…4 However, there is no such restriction in the definition of BE in Japan, where BE is generously diagnosed solely based on the endoscopic identification of columnar-lined esophagus at any length without the need for a cumbersome histological confirmation. 5 Consequently, shorter forms of BE are very frequently diagnosed, being detected in 15-80% of operated endoscopic examinations in Japan, [6][7][8][9][10] whereas this rate is only 5-20% in Western countries. 11,12 Given that the incidence of EAC is much lower in Japan at present than in Western counties, 13,14 BE as a premalignant lesion for EAC is clearly over-diagnosed in Japan.…”

Endoscopic diagnosis and screening of Barrett's esophagus: Inconsistency of diagnostic criteria between Japan and Western countries

“…reported that the prevalence of BE with a length of less than 1 cm was 56.2%, while that with a length of ≥ 1 cm was 26.2% when LCI was used to determine the area of BE, as the distal end of the palisade vessels was easily visualized. 42 We investigated the inter‐institutional variability in the diagnosis of BE at four different hospitals. Because of cases of over‐ and under‐diagnosis, we demonstrated that the variance was unacceptably large (17.2%–96.8%), and the diagnostic accuracy was inadequate, especially in cases with a BE length of less than 1 cm, suggesting that the minimum length of CLE should be defined in future criteria in Japan.…”