TY - JOUR
T1 - The value of traditional upper endoscopy as a diagnostic test for Barrett's esophagus
AU - Wang, Amy
AU - Mattek, Nora C.
AU - Corless, Christopher L.
AU - Lieberman, David A.
AU - Eisen, Glenn M.
N1 - Funding Information:
The authors report that there are no disclosures relevant to this publication. This project was supported with funding from NIDDK UO1 CA 89389-01 and R33-DK61778-01. In addition, the practice network (CORI) received support from the following entities to support the infrastructure of the practice-based network: AstraZeneca, Novartis, Bard International, Pentax USA, ProVation, Endosoft, GIVEN Imaging, and Ethicon. The commercial entities had no involvement in this research. D. A. Lieberman is the executive director of the CORI, a non-profit organization that receives funding from federal and industry sources. The CORI database was used in this study. This potential conflict of interest has been reviewed and managed by the Oregon Health and Science University Conflict of Interest in Research Committee .
PY - 2008/11
Y1 - 2008/11
N2 - Background: The standard test for diagnosing Barrett's esophagus (BE) is a conventional upper endoscopy. However, studies have shown that confirmation of BE by endoscopy with histologic intestinal metaplasia can be difficult. Objective: To determine the overall accuracy, as well as factors that influence the accuracy of a conventional upper endoscopy in diagnosing BE. Setting: Thirteen academic, community, and Veterans Affairs sites. Design: A retrospective data review. Patients: Patients who underwent an upper endoscopy with a finding of "suspected Barrett's esophagus" and esophageal biopsies. Pathology reports were examined to identify cases with intestinal metaplasia. Main Outcome Measurements: Percentage of pathology-confirmed BE among suspected cases. Results: A total of 2511 procedures were examined; the frequency of biopsy-confirmed BE was 48.4%. Multivariate logistic regression identified the following factors to be independently associated with biopsy-confirmed BE: long-segment BE that measured ≥3 cm (odds ratio [OR] 4.61 [95% CI, 3.73-5.69]), male sex (OR 1.82 [95% CI, 1.49-2.22]), increasing age (age interval 70-79 years with OR 2.33 compared with age <50 years [95% CI, 1.75-3.10]), the presence of a hiatal hernia (OR 1.46 [95% CI, 1.22-1.84]), and white race (OR 1.90 [95% CI, 1.49-2.22]). Limitations: Biopsy specimens were assumed to sample the tubular esophagus; the actual pathology slides were not reevaluated by the investigators. Conclusions: Endoscopic evaluation has limitations for the diagnosis of BE. Specific patient and endoscopic characteristics may be associated with the confirmation of BE on biopsy specimens. Further study is needed to determine if new endoscopic imaging technologies improve the ability to correctly identify BE.
AB - Background: The standard test for diagnosing Barrett's esophagus (BE) is a conventional upper endoscopy. However, studies have shown that confirmation of BE by endoscopy with histologic intestinal metaplasia can be difficult. Objective: To determine the overall accuracy, as well as factors that influence the accuracy of a conventional upper endoscopy in diagnosing BE. Setting: Thirteen academic, community, and Veterans Affairs sites. Design: A retrospective data review. Patients: Patients who underwent an upper endoscopy with a finding of "suspected Barrett's esophagus" and esophageal biopsies. Pathology reports were examined to identify cases with intestinal metaplasia. Main Outcome Measurements: Percentage of pathology-confirmed BE among suspected cases. Results: A total of 2511 procedures were examined; the frequency of biopsy-confirmed BE was 48.4%. Multivariate logistic regression identified the following factors to be independently associated with biopsy-confirmed BE: long-segment BE that measured ≥3 cm (odds ratio [OR] 4.61 [95% CI, 3.73-5.69]), male sex (OR 1.82 [95% CI, 1.49-2.22]), increasing age (age interval 70-79 years with OR 2.33 compared with age <50 years [95% CI, 1.75-3.10]), the presence of a hiatal hernia (OR 1.46 [95% CI, 1.22-1.84]), and white race (OR 1.90 [95% CI, 1.49-2.22]). Limitations: Biopsy specimens were assumed to sample the tubular esophagus; the actual pathology slides were not reevaluated by the investigators. Conclusions: Endoscopic evaluation has limitations for the diagnosis of BE. Specific patient and endoscopic characteristics may be associated with the confirmation of BE on biopsy specimens. Further study is needed to determine if new endoscopic imaging technologies improve the ability to correctly identify BE.
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U2 - 10.1016/j.gie.2008.02.064
DO - 10.1016/j.gie.2008.02.064
M3 - Article
C2 - 18514655
AN - SCOPUS:54449091275
SN - 0016-5107
VL - 68
SP - 859
EP - 866
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 5
ER -