Endoscopy 2018; 50(04): S135
DOI: 10.1055/s-0038-1637433
ESGE Days 2018 ePosters
Georg Thieme Verlag KG Stuttgart · New York

HIGH PREVALENCE OF INTESTINAL METAPLASIA IN DIMINUTIVE ELEVATED LESIONS AT GASTROESOPHAGEAL JUNCTION AND THEIR NARROW BAND IMAGING CHARACTERISTICS

A Ramaswamy Saraswathy
1   Madras Medical Mission, Institute of Gastroenterology and Liver Disease, Chennai, India
,
A Chacko
1   Madras Medical Mission, Institute of Gastroenterology and Liver Disease, Chennai, India
,
PJ Koshy
1   Madras Medical Mission, Institute of Gastroenterology and Liver Disease, Chennai, India
,
M Mathan
1   Madras Medical Mission, Institute of Gastroenterology and Liver Disease, Chennai, India
,
MA Arvind
1   Madras Medical Mission, Institute of Gastroenterology and Liver Disease, Chennai, India
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

To study the prevalence of Barrett's esophagus (intestinal metaplasia) in subjects with diminutive elevated lesions at the gastroesophageal junction and the contribution of narrow band imaging (NBI) in characterizing these lesions.

Methods:

Prospective observational study of all subjects with diminutive elevated lesions at gastroesophageal junction detected during endoscopy from 1st January 2013 to 31st August 2017 at a single tertiary care centre in southern India. Narrow band imaging (NBI) was performed on all subjects by a single endoscopist experienced in NBI and histopathology was independently evaluated by two pathologists.

Results:

Out of 3804 subjects who underwent upper GI endoscopy during the study period, 308 (8.1%) were detected to have diminutive elevated lesions at gastroesophageal junction. Biopsy was not performed on 31 subjects due to a variety of reasons including unacceptable risk of bleed and lack of informed consent for biopsy. Out of 277 subjects who had biopsy, 34 showed intestinal metaplasia (IM) consistent with Barrett's esophagus suggesting that the prevalence of intestinal metaplasia in diminutive elevated lesions at gastroesophageal junction was 11% (34/308). No endoscopic features suspicious of Barrett's esophagus were seen in 14/34 (41.2%) of subjects who had diminutive elevated lesions (DEL) and intestinal metaplasia (IM). Among subjects with intestinal metaplasia, 30 had narrow band imaging without magnification; NBI was able to predict histology correctly in 22/30 (73.3%).

Conclusions:

There is a high prevalence of intestinal metaplasia in diminutive elevated lesions of gastroesophageal junction. Diminutive elevated lesions (DEL) is an early pointer to presence of intestinal metaplasia even in the absence of other endoscopic features of Barrett's esophagus. This suggests that all diminutive elevated lesions (DEL) at gastroesophageal junction should be biopsied to rule out intestinal metaplasia.