Introduction High grade dysplasia (HGD) is often reported after Seattle protocol biopsies have been taken or the exact position of a targeted lesion within a Barrett’s segment has not been precisely documented.
We investigated how often the histology of subsequent endoscopic resection agreed with the initial biopsy of HGD.
Method We searched our prospectively maintained database for patients referred for endoscopic therapy of high grade dysplasia or early cancer in Barrett’s oesophagus. All biopsies from referring hospitals had been reviewed and confirmed by our expert pathologists. Endoscopy was routinely performed using acetic acid spraying and narrow band imaging to identify and delineate lesions for endoscopic resection. Endoscopic resection was performed using band ligation mucosectomy.
Results 100 patients with HGD (71) or early cancer (29) were included. In 34 (47.9%) of the patients with HGD on biopsy, no lesion or abnormality had been reported on the initial endoscopy report.
In all of the cancer patients and in 70 (98.6%) of the HGD patients a suspicious lesion could be identified using advanced imaging. One patient with focal HGD but without detectable mucosal lesion was directly treated using RFA.
EMR confirmed HGD in 35 of 70 (50%) patients with HGD on initial biopsy but upgraded to intramucosal in 30 patients (42.8%) and to submucosal cancer in 5 patients (7.1%).
Conclusion High grade dysplasia in Barrett’s oesophagus is almost always detectable using acetic acid spraying and/or narrow band imaging. Endoscopic resection of all detected lesions before RFA is recommended due to the high risk of intramucosal and even submucosal cancer.
Disclosure of interest None Declared.
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