Surveillance of short‐segment Barrett's esophagus using ultrathin transnasal endoscopy

Abstract

Background and Aim: Newly developed ultrathin transnasal endoscope, the GIF-XP290N, makes possible a resolving power similar to the GIF-H260 at a distance of 3 mm. We conducted surveillance of subjects with Barrett's esophagus using this ultrathin transnasal endoscopy. In Japan the lower margin of the lower esophageal palisade vessels is defined the gastroesophageal junction in deep inspiration. We diagnose Barrett's esophagus if columnar epithelium is present on the oral side of the gastroesophageal junction. Methods and Results: Barrett's esophagus was confirmed in 116 out of 135 subjects (85.9%), with 17 cases of short-segment Barrett's esophagus (SSBE) and 99 of ultra-shortsegment Barrett's esophagus. Close observation of the Barrett's esophagus mucosal structural pattern using narrow band imaging revealed 29 cases with an oval or round pattern, 29 with a long straight pattern, 47 with a villous pattern, 8 with a cerebriform pattern, and 6 with an irregular pattern according to Goda classification. Mucosal biopsies from all subjects with SSBE are examined. Histological examination revealed intestinal metaplasia in only eight subjects. We grouped the oval/round and long straight patterns as closed type, and the villous, cerebriform, and irregular patterns as open type. Analysis of the relationship between these mucosal patterns and background factors revealed a significant correlation between intestinal metaplasia and the open-type pattern. Conclusion: We consider this new ultrathin transnasal endoscopy to be a useful technique for surveillance of Barrett's esophagus, especially SSBE.

Circumferential Locations of Different Shapes of Short-segment Barrett's Esophagus

“…In the present study, we made a diagnosis of BE when the length was ≥10 mm and noted a prevalence of 5.2% in subjects who underwent an endoscopic examination as part of an annual medical checkup. The prevalence of BE in our subjects was lower than that in other Japanese groups, including recent endoscopic studies that found that 20.8-85.9% of participants had BE, including ultra-short-segment BE ( 11 , 12 ). Therefore, a majority of endoscopically observed cases of SSBE in Japanese subjects seems to be <10 mm in length.…”

“…Indeed, the rate of incidence of adenocarcinoma development in the esophagogastric junction has also been gradually increasing in Asia ( 3 , 7 - 10 ). In Japan, while the prevalence of long-segment Barrett's esophagus (LSBE) is rare, the number of cases of adenocarcinoma developing from short-segment Barrett's esophagus (SSBE) has increased ( 3 , 7 - 12 ). As a result, patients with SSBE are considered to be the main population in Asian countries requiring endoscopic surveillance to detect esophageal adenocarcinoma.…”

Office-based procedures for diagnosis and treatment of esophageal pathology

“…13,22,68 Catanzaro et al 13 Table 1. 6,7,9,10,[13][14][15][16][17][18][19][20][21][22][23][24][25][27][28][29][30][32][33][34]37,38,[40][41][42][43][44]46,49,50,52,53,[56][57][58][59][60]62,64,[68][69][70][71][72]…”

Monitoring the premalignant potential of Barrett's oesophagus'

“…Ultra-thin nasal endoscopes now exist and appear to be able to detect BE reasonably accurately. 53 54 The issues of scope reprocessing may also have been overcome with a disposable over-sheath. 55 Cytosponge A capsule-on-a-string cytology collection device developed in Cambridge (the Cytosponge), coupled with an immuno-based assay, has a high sensitivity for detecting BE without endoscopy.…”