Adequacy of esophageal squamous mucosa specimens obtained during endoscopy: are standard biopsies sufficient for postablation surveillance in Barrett%26apos;s esophagus?

作者：Gupta Neil; Mathur Sharad C; Dumot John A; Singh Vikas; Gaddam Srinivas; Wani Sachin B; Bansal Ajay; Rastogi Amit; Goldblum John R; Sharma Prateek^*

来源：Gastrointestinal Endoscopy, 2012, 75(1): 11-18.

DOI：10.1016/j.gie.2011.06.040

Background: After endoscopic eradication therapy (EET) for Barrett%26apos;s esophagus (BE), surveillance of residual/recurrent intestinal metaplasia/dysplasia including subsquamous tissue is performed by using biopsy forceps. %26lt;br%26gt;Objective: The goal of this study was to compare the adequacy of biopsy specimens obtained from neosquamous (post-EET patients) and native (non-BE patients) squamous mucosa. %26lt;br%26gt;Design: A case-control study using squamous biopsy specimens obtained at 2 tertiary referral centers was conducted. %26lt;br%26gt;Interventions: Two experienced GI pathologists reviewed specimens from patients with neo- (post-EET patients) and native (non-BE patients) squamous mucosa in a blinded fashion after developing standardized criteria to assess tissue depth. %26lt;br%26gt;Main Outcome Measurements: The primary outcome was the proportion of biopsy specimens that contained any amount of lamina propria. %26lt;br%26gt;Results: A total of 193 biopsy specimens (1692 tissue pieces) from 104 patients were reviewed: 163 neo- and 30 native squamous. Of all biopsy specimens, only 37% contained any amount of lamina propria, and, furthermore, fewer than 4% of specimens had sufficient lamina propria (ie, more than two thirds of the entire squamous tissue present). When examining individual squamous tissue pieces, fewer than 11% contained lamina propria. No statistically significant differences in the presence of lamina propria were detected between neo-and native squamous mucosa. %26lt;br%26gt;Conclusion: The majority of esophageal squamous biopsy specimens obtained during endoscopy do not demonstrate lamina propria and subepithelial structures. This is true for both neo- and native squamous mucosa. Biopsy specimens of neo-squamous mucosa obtained after EET appear to be inadequate to exclude subsquamous intestinal metaplasia/dysplasia because lamina propria is not present in more than 60% of specimens. This has larger implications in the clinical management of BE patients after EET. (Gastrointest Endosc 2012;75:11-8.)

• 出版日期2012-1