Russin Michelle, Harbrecht Matthew, Mishra Ankit, Peddu Dhiraj, Kubina Matthew, Chang Joy W, Burns Jennifer A, Arasim Maria E, Rubenstein Joel H
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
Clin Gastroenterol Hepatol. 2025 Apr 30. doi: 10.1016/j.cgh.2025.02.016.
BACKGROUND & AIMS: Guidelines differ on the definition of Barrett's esophagus (BE). We aimed to estimate the detection rate of esophagogastroduodenoscopy (EGD) with biopsy for BE, using longitudinal outcome of adenocarcinoma of the esophagus or esophagogastric junction (EAC, EGJAC) as the gold standard.
We performed retrospective analyses of US Veterans with EAC/EGJAC between 2017 and 2021 who had an EGD before cancer diagnosis. We reviewed a random sample of 200 cases of EAC and 100 cases of EGJAC to tabulate the detection rate of EGD with biopsy, stratified by Siewert classification (S1 or S2).
After manual review, there were 136 S1 and 108 S2 cases. Among patients with endoscopic suspicion of BE who had biopsies, 96.8% of S1 and 97.9% of S2 had intestinal metaplasia (IM). BE defined as ≥1 cm with IM had a detection rate of 66.2% for S1 and 39.8% for S2. When restricted to EGDs with appropriate biopsies, the detection rate of ≥1 cm with IM improved to 70.3% in S1 and 41.4% in S2. Seventy-three percent of S1 cases and 90% of S2 cases without BE diagnosed were related to lack of endoscopic suspicion for BE. BE or a visible lesion was present in 70% of photographs from EGDs not suspected of having BE by the original endoscopist.
IM seems required for development of EAC and likely EGJAC. EGD with biopsy had only modest rate for detecting a precursor state for subsequent adenocarcinoma and was lower for S2 compared with S1. Variability in endoscopic suspicion, including segments <1 cm, are potential areas for improvement in detection of BE by EGD.
巴雷特食管（BE）的定义在不同指南中存在差异。我们旨在以食管或食管胃交界腺癌（EAC、EGJAC）的纵向结局作为金标准，评估经活检的食管胃十二指肠镜检查（EGD）对BE的检出率。
我们对2017年至2021年间患有EAC/EGJAC且在癌症诊断前接受过EGD检查的美国退伍军人进行了回顾性分析。我们回顾了200例EAC和100例EGJAC的随机样本，以列出经活检的EGD的检出率，并按Siewert分类（S1或S2）进行分层。
经人工审核，有136例S1病例和108例S2病例。在内镜检查怀疑有BE并进行活检的患者中，96.8%的S1病例和97.9%的S2病例有肠化生（IM）。定义为≥1 cm且有IM的BE在S1中的检出率为66.2%，在S2中的检出率为39.8%。当仅限于进行了适当活检的EGD时，≥1 cm且有IM的检出率在S1中提高到70.3%，在S2中提高到41.4%。73%的S1病例和90%的未诊断为BE的S2病例与内镜未怀疑有BE有关。在最初的内镜医师未怀疑有BE的EGD照片中，70%存在BE或可见病变。
IM似乎是EAC以及可能的EGJAC发生所必需的。经活检的EGD对后续腺癌前驱状态的检出率仅为中等水平，且S2的检出率低于S1。内镜怀疑的变异性，包括<1 cm的节段，是通过EGD检测BE时潜在的可改进领域。
