Endoscopic versus histological diagnosis of Barrett’s esophagus: a cross-sectional survey

Context : Barrett’s esophagus is a common pathological condition in patients with gastro-esophageal reflux disease.

Objective : The aim of this study was to compare endoscopic diagnosis versus histological confirmation.

Design : Cross-sectional. Setting: Cancer Institute of the Imam Khomeini Hospital.

Material and methods : A total of 50 patients with a history of gastro-esophageal reflux were recruited and underwent upper endoscopy at this cross-sectional survey. Four-quadrant biopsy was taken from all suspected areas of intestinal metaplasia. Sections of blocks were stained with Mixed Alcian Blue (PH 2.5)/PAS and haematoxylin-eosin stainings for the diagnosis of intestinal metaplasia (complete vs. incomplete types) and goblet cell / columnar cell / dysplasia, respectively.

Main outcome measure : The presence of Helicobacter pylori was assessed by Giemsa staining.

Results : There were 44 cases of short-segment Barrett’s esophagus and 6 of long-segment Barretts esophagus by endoscopy. When examined by histologic examination, 12 patients with short-segment Barrett’s esophagus and 4 with long-segment Barrett’s esophagus had intestinal metaplasia. Haematoxylin-eosin staining diagnosed 12 cases of intestinal metaplasia, whereas mixed alcian blue/PAS was used to diagnose 16 cases (κ = 80%, p < 0.001). The positive predictive value in the diagnosis of goblet cell metaplasia and columnar cell metaplasia was 32% and 66%, respectively. Helicobacter pylori infection was observed in 10 cases of those with columnar cell metaplasia without goblet cells, while none of the patients with intestinal metaplasia were infected.

Conclusion : Our findings suggest that biopsy taking is necessary in all patients with gastro-esophageal reflux disease, whose results suggest columnar cell lining in distal esophagus in endoscopy.