Endoscopic Features for Recognizing Buried Barrett’s Esophagus

Endoscopic Features for Recognizing Buried Barrett’s Esophagus

Prateek Sharma, MD, FASGE, reviewing Yang LS, et al. Gastrointest Endosc 2020 Dec 25.

Buried Barrett’s esophagus (BE) mucosa, or subsquamous intestinal metaplasia, is defined as intestinal metaplasia that is present under a lining of endoscopically intact squamous epithelium. It has been reported in up to 28% of treatment-naïve patients with BE and 14% of patients after endoscopic therapy for BE. However, this diagnosis poses challenges: Were biopsy samples obtained from the squamous mucosa or endoscopically appearing columnar areas such as islands or tongues? Several experts have proposed that due to a lack of clear endoscopic features, specimens obtained for biopsy are truly random, which might contribute to this erroneous diagnosis of buried BE. 

The authors of this study arrived at a consensus on 2 endoscopic features of buried BE: (1) squamous epithelium, which appears darker pink with white-light endoscopy (WLE) or darker brown with narrow-band imaging (NBI), and (2) a slightly raised or nodular appearance of the mucosa. These findings were evaluated in a single-center retrospective review of 506 patients with dysplastic BE, both treatment-naïve and treated with postendoscopic therapy. Overall, 33 patients (7%) had histological evidence of buried BE, with 26 of these patients (79%) showing endoscopic suspicion of buried BE using the criteria mentioned. Twenty-four percent of the patients had darker pink (WLE) or darker brown (NBI) squamous epithelium, 27% had slightly raised or nodular mucosal appearance, and 27% had both features. Of the 12 patients with dysplasia in buried BE, 92% had positive endoscopic features. The pretest characteristics suggested that the sensitivity, specificity, and positive-predictive value of identifying buried BE using these endoscopic criteria were 79%, 31%, and 59%, respectively.

Prateek Sharma, MD, FASGE

COMMENT

Buried BE may be histologically diagnosed in less than 10% of patients with BE (both treatment naïve and previously treated endoscopically) undergoing endoscopy. Endoscopic features, such as the presence of darker pink mucosa and slightly raised/nodular mucosa on WLE and darker brown squamous mucosa on NBI, may help in obtaining targeted biopsy samples to increase the diagnosis of buried BE.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Yang LS, Holt BA, Williams R, et al. Endoscopic features of buried Barrett’s mucosa. Gastrointest Endosc 2020 Dec 25. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2020.12.031)

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