Sanjeev Slehria, MD, Prateek Sharma, MD


Curr Opin Gastroenterol. 2003;19(4) 

In This Article

Techniques for Metaplasia and Dysplasia Detection

Barrett esophagus is detected in approximately 10% of patients undergoing endoscopy for GERD. Annual costs of surveillance using current standard endoscopy and random biopsies in the United States would be astronomical, close to $350 million as suggested by various models. Transnasal upper endoscopy has been shown in a pilot study to be cost-effective, feasible, and accurate for identification and histologic confirmation of Barrett metaplasia, with the histologic yield for dysplasia comparable to conventional upper endoscopy.[18*]

The use of techniques such as chromoendoscopy, magnification endoscopy, or spectroscopy has recently shown to help target areas suspected to have intestinal metaplasia and dysplasia and may increase the yield on initial endoscopy. Vital staining can be beneficial if it identifies more patients with Barrett esophagus. Confirmation of intestinal metaplasia in patients with suspected SSBE by using methylene blue-directed biopsies was done in a group of 75 patients and compared with a control group of 83 patients who had undergone random biopsies by Sharma et al..[19*] Intestinal metaplasia was detected in 61% of the methylene blue group vs 42% of the control group (P = 0.0237). Patients in the methylene blue group required significantly fewer biopsies. Dysplasia in Barrett esophagus is currently diagnosed by random biopsies, subject to targeting and sampling error. New techniques could be effective. Preliminary studies suggest that protoporphyrin IX fluorescence resulting from exogenously administrated 5-aminolevulinic acid may improve the detection of dysplastic mucosa in the gastrointestinal tract.[20] Patients were given 10 mg/kg of aminolevulinic acid orally 3 hours before endoscopy. By using protoporphyrin IX fluorescence alone, HGD dysplasia was distinguished from nondysplastic tissues types with 77% sensitivity and 71% specificity.


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