Correlation between Endoscopically Suspected Esophageal Metaplasia and Barrett’s Esophagus: A Single Center Experience

Background: Barrett’s esophagus (BE) is defined as a suspect endoscopic finding followed by pathologically proven specific intestinal metaplasia as opposed to the normal squamous epithelium of the esophagus. A new BE classification, the Prague C and M criteria, was proposed in 2006 to define the extent of BE based on the circumference (C) and maximum diameter (M) of the lesion.

AIM: In this study, we adopted Prague C and M criteria to record endoscopically suspected esophageal metaplasia (ESEM); biopsies were subsequently taken to determine any correlation between ESEM and histologically proven BE. The risk factors of BE were also investigated.

Methods: This was an observational study. From June 2006 to June 2009, 62 cases of ESEM were enrolled with subsequent standardized random biopsies (four pieces were taken every 2 cm from the four quarters of the esophagus). BE was defined by histological verification of specialized intestinal metaplasia (SIM). Data were analyzed to identify correlations between ESEM and BE. Logistic regression models were used to investigate the relationship between age, gender, hiatal hernia, long-segment metaplasia (LS defined as maximal extension greater than 3 cm from the SCJ), and BE. A multi-variate regression model was also used.

Results: A total of 6836 subjects who underwent endoscopic examination were enrolled from June 2006 to June 2009. Of these, 42 BE subjects were confirmed among 62 ESEM cases; the prevalence of BE among cases that received endoscopy was 0.61%. Long-segment ESEM was more prevalent than short segment (LS: SS = 43:19). Several factors such as age, gender, hiatal hernia, and LS were analyzed using a regression model; this model revealed that only LS ESEM predicted BE with borderline significance (p = 0.07). However, a multi-variate regression model including all the factors revealed that males with ESEM were significantly associated with BE (p = 0.015).

Conclusion: This study was performed in single center and used Prague C and M criteria to record ESEM. The use of Prague C and M criteria to record ESEM yielded a histological verification of BE rate of 67.7%. A standardized random quadruple biopsy to validate BE should be routinely performed. LS metaplasia was a single predictor of BE with borderline significance and male sex was a significant predictor of BE.