Overdiagnosis of Barrett Esophagus Upon systematic re-evaluation of 130 patients, one third had their previous diagnosis of BE reversed. Prevalence estimates of Barrett esophagus (BE) have ranged from 1% to 25% among patients who experienced heartburn >3 times per week. One challenge to the validity of BE diagnosis has been variable interpretation of endoscopic findings. In this current study, three investigators received didactic and endoscopic consensus training and re-evaluated 130 patients who had been previously diagnosed with BE. A standard biopsy protocol was used, with pathology reviewed by an expert gastrointestinal pathologist. 32% of patients had their diagnosis of BE revised to no BE. Diagnosis was revised in 41% of patients with short-segment BE and in 3% with long-segment BE. Significant predictors of a revised diagnosis included initial diagnosis from outside of the study practices group, younger age, female gender, and absence of a hiatal hernia. These findings highlight the need for a better definition of the gastroesophageal junction (GEJ), in particular for short-segment BE. Accurate recognition of the proximal margins of the gastric folds, full gastric insufflation to distend the GEJ (especially when a hiatal hernia is present), and biopsies from the lesser curvature at the cardia below the GEJ (assessment for gastric metaplasia to prevent misinterpretation as short-segment BE) may help prevent an inaccurate diagnosis of BE.
Posted on: Wed, 30 Apr 2014 03:06:36 +0000
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