Esophageal dysplasia and chronic esophagitis: detection at upper gastrointestinal tract endoscopy

Cancer of the esophagus becomes symptomatic at an advanced phase with a late diagnosis, when the tumor is already incurable. Early diagnosis has been shown to improve the survival rates. Conventional esophagoscopy is largely available but its sensitivity to detect early cancer or precancerous lesions remains controversial. In this study we tested the sensitivity of conventional esophagoscopy to identify suspicious areas and compared to histopathology of endoscopic biopsies to detect dysplasia and chronic esophagitis in a population at risk for cancer in southern Brazil. Adult males scheduled to have outpatient endoscopy were examined by two experienced endoscopists and any small (< 5 mm) plaque, nodule, erosion, hyperemia and or friable areas of the mucosa were biopsied and looked for the presence of early cancer or precancerous lesions. Normal appearing mucosa at the middle third of the esophagus was also biopsied and results compared for sensitivity, specificity, positive and negative predictive value. Of the 89 individuals with satisfactory biopsies, 3 had dysplasias, 29 moderate or severe chronic esophagitis and 57 normal findings at the histopathological study. We found no early cancer. We found two large, vegetating lesions confirmed to be advanced squamous cell carcinoma but they were excluded from analysis. To detect dysplasia or moderate/severe chronic esophagitis conventional esophagoscopy had a sensitivity of 40.6%, specificity of 78.9%, positive predictive value of 52% and negative predictive value of 70.3.

In this study, conventional esophagoscopy had a low sensitivity to detect dysplasias and/or chronic esophagitis and techniques to improve endoscopic identification of these lesions in individuals at risk for cancer are much needed.