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Diagnosing dysplasia in Barrett’s oesophagus still requires Seattle protocol biopsy in the era of modern video endoscopy: results from a tertiary centre Barrett’s dysplasia database.

Nachiappan, Arun; Ragunath, Krish; Card, Timothy; Kaye, Philip

Diagnosing dysplasia in Barrett’s oesophagus still requires Seattle protocol biopsy in the era of modern video endoscopy: results from a tertiary centre Barrett’s dysplasia database. Thumbnail


Authors

Arun Nachiappan

Krish Ragunath

Dr TIM CARD tim.card@nottingham.ac.uk
Clinical Associate Professor

Philip Kaye



Abstract

Objectives: The role of random, four-quadrant biopsy (i.e. systematic biopsy) in Barrett’s oesophagus surveillance has been questioned given its drawbacks and the emergence of high-resolution endoscopy and advanced imaging modalities. Our study aims to assess whether neoplastic pathology is typically diagnosed in routine clinical practice by random, four-quadrant or targeted biopsy whilst using high-resolution endoscopy.

Methods: The Nottingham University Hospital Barrett’s oesophagus dysplasia database was retrospectively analysed. Endoscopic and histopathologic data pertaining to the initial endoscopy in which pathology was diagnosed was extracted from the medical records. The most advanced histopathologic abnormality at initial diagnosis and within twelve months were noted. The corresponding endoscopic impression at initial diagnosis was used to group cases per type of biopsy – random, four-quadrant or targeted. Pearson’s chi-squared test of independence was used to analyse the relationship between the type of biopsy and diagnosis, indication for endoscopy, endoscopist level and advanced techniques used.

Results: Of the 222 patients involved in the study - a higher proportion were diagnosed through random, four-quadrant biopsy (72.97%) than targeted biopsy (27.03%). 90.91% of low-grade dysplasia, 71.43% of high-grade dysplasia and 50% of intramucosal adenocarcinoma cases were diagnosed by random, four-quadrant biopsy. Across all grades of clinicians, patients were typically diagnosed through random, four-quadrant biopsy. However, amongst specialist consultant endoscopists (n=10) the proportion was equal.

Conclusions: Our findings strongly emphasize the importance of random, four-quadrant biopsy in the detection of not only low-grade dysplasia, but also high-grade dysplasia and early invasive carcinoma as part of Barrett’s oesophagus surveillance.

Citation

Nachiappan, A., Ragunath, K., Card, T., & Kaye, P. (2019). Diagnosing dysplasia in Barrett’s oesophagus still requires Seattle protocol biopsy in the era of modern video endoscopy: results from a tertiary centre Barrett’s dysplasia database. Scandinavian Journal of Gastroenterology, 55(1), 9-13. https://doi.org/10.1080/00365521.2019.1706762

Journal Article Type Article
Acceptance Date Dec 13, 2019
Online Publication Date Dec 27, 2019
Publication Date Dec 27, 2019
Deposit Date Feb 18, 2020
Publicly Available Date Mar 28, 2024
Journal Scandinavian Journal of Gastroenterology
Print ISSN 0036-5521
Electronic ISSN 1502-7708
Publisher Taylor and Francis
Peer Reviewed Peer Reviewed
Volume 55
Issue 1
Pages 9-13
DOI https://doi.org/10.1080/00365521.2019.1706762
Keywords Barrett’s oesophagus, surveillance, adenocarcinoma, dysplasia, endoscopy
Public URL https://nottingham-repository.worktribe.com/output/3983522
Publisher URL https://www.tandfonline.com/doi/full/10.1080/00365521.2019.1706762
Additional Information This is an Accepted Manuscript of an article published by Taylor & Francis in Scandinavian Journal of Gastroenterology on27/12/2019, available online: https://www.tandfonline.com/doi/full/10.1080/00365521.2019.1706762