Top 10 Practice Changers in Gastroenterology: 2014

David A. Johnson, MD


December 09, 2014

In This Article

Barrett's Esophagus Is Frequently Overdiagnosed in Clinical Practice: Results of the Barrett's Esophagus Endoscopic Revision (BEER) Study

Ganz RA, Allen JI, Leon S, Batts KP
Gastrointest Endosc. 2014;79:565-573

Can Incorrect Diagnosis of Barrett Esophagus Be Avoided?

Prevalence estimates for Barrett esophagus (BE) vary; an early estimate was 12% among patients who experienced heartburn more than three times per week, but subsequent rates have ranged from 1% to 25%. One challenge to the validity of BE diagnosis has been variable interpretation of endoscopic findings.

In this report, three expert investigators reevaluated 130 patients who had been previously diagnosed with BE. Disparities were resolved by consensus review. In 42 patients (32%), the diagnosis of BE was revised to no BE, and intestinal metaplasia of the cardia was evident in five of these patients (12%).

These findings highlight the need for better definition of the gastroesophageal junction (GEJ), in particular when biopsy samples are obtained for short-segment BE. Accurate recognition of the proximal margins of the gastric folds is key, with particular care being taken to fully insufflate and distend the GEJ, especially when a hiatal hernia is present. Biopsy samples should be obtained from the lesser curvature at the cardia below the GEJ, because gastric metaplasia might be misinterpreted as short-segment BE. The insurability issues, cost, and psychological impact associated with an incorrect diagnosis of BE are considerable, and these should be avoided.



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