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CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(08): E736-E742
DOI: 10.1055/a-2102-7726
Original article

Endoscopic features of low-grade dysplastic Barrett’s

Tony He
1   Gastroenterology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Australia (Ringgold ID: RIN60078)
2   Faculty of Medicine, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Australia (Ringgold ID: RIN85084)
,
Kiran Gopinath Iyer
1   Gastroenterology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Australia (Ringgold ID: RIN60078)
,
Mark Lai
1   Gastroenterology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Australia (Ringgold ID: RIN60078)
,
Eloise House
3   Pathology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Australia (Ringgold ID: RIN60078)
,
John L Slavin
3   Pathology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Australia (Ringgold ID: RIN60078)
,
Bronte Holt
1   Gastroenterology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Australia (Ringgold ID: RIN60078)
2   Faculty of Medicine, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Australia (Ringgold ID: RIN85084)
,
Edward H Tsoi 
4   Gastroenterology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Australia (Ringgold ID: RIN60078)
2   Faculty of Medicine, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Australia (Ringgold ID: RIN85084)
,
Paul Desmond
1   Gastroenterology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Australia (Ringgold ID: RIN60078)
2   Faculty of Medicine, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Australia (Ringgold ID: RIN85084)
,
Andrew C F Taylor
1   Gastroenterology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Australia (Ringgold ID: RIN60078)
2   Faculty of Medicine, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Australia (Ringgold ID: RIN85084)
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Low-grade dysplasia on Barrett’s esophagus: visible or not ?Endosc Int Open 2023; 11(09): E816-E817
DOI: 10.1055/a-2145-5564

Abstract

Background and study aims Barrett’s esophagus (BE) with low-grade dysplasia (LGD) is considered usually endoscopically invisible and the endoscopic features are not well described. This study aimed to: 1) evaluate the frequency of visible BE-LGD; 2) compare rates of BE-LGD detection in the community versus a Barrett’s referral unit (BRU); and 3) evaluate the endoscopic features of BE-LGD.

Patients and methods This was a retrospective analysis of a prospectively observed cohort of 497 patients referred to a BRU with dysplastic BE between 2008 and 2022. BE-LGD was defined as confirmation of LGD by expert gastrointestinal pathologist(s). Endoscopy reports, images and histology reports were reviewed to evaluate the frequency of endoscopically identifiable BE-LGD and their endoscopic features.

Results A total of 135 patients (27.2%) had confirmed BE-LGD, of whom 15 (11.1%) had visible LGD identified in the community. After BRU assessment, visible LGD was detected in 68 patients (50.4%). Three phenotypes were observed: (A) Non-visible LGD; (B) Elevated (Paris 0-IIa) lesions; and (C) Flat (Paris 0-IIb) lesions with abnormal mucosal and/or vascular patterns with clear demarcation from regular flat BE. The majority (64.7%) of visible LGD was flat lesions with abnormal mucosal and vascular patterns. Endoscopic detection of BE-LGD increased over time (38.7% (2009–2012) vs. 54.3% (2018–2022)).

Conclusions In this cohort, 50.4% of true BE-LGD was endoscopically visible, with increased recognition endoscopically over time and a higher rate of visible LGD detected at a BRU when compared with the community. BRU assessment of BE-LGD remains crucial; however, improving endoscopy surveillance quality in the community is equally important.

Keywords

Barrett's and adenocarcinoma - Endoscopy Upper GI Tract - Diagnosis and imaging (inc chromoendoscopy, NBI, iSCAN, FICE, CLE) - Endoscopic resection (ESD, EMRc, ...) - Quality and logistical aspects - Image and data processing, documentatiton


Publication History

Received: 15 March 2023

Accepted after revision: 25 May 2023

Accepted Manuscript online:
30 May 2023

Article published online:
07 August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
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Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2023; 55(10): 978-978
DOI: 10.1055/a-2142-1348

 

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