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Endoscopic ultrasound in the evaluation of Barrett's esophagus: a preliminary report
A K Srivastava1, A Vanagunas, P Kamel
1Department of Medicine, Northwestern University Medical School, Chicago, Illinois.
Objective:
Endoscopic screening of Barrett's esophagus (BE) for dysplasia is imprecise and controversial. Endoscopic ultrasound (EUS) allows a detailed circumferential image of the esophageal wall. Our objective in this study was to assess the utility of EUS for surveillance in Barrett's esophagus.
Methods:
Consecutive patients with proven BE undergoing endoscopy were evaluated with EUS. Esophageal wall thickness (EWT) was measured as the distance from the balloon-mucosal interface to the outermost hyperechoic line. EWT was determined as the average of all measurements done every 2-3 cm along the esophagus. Identical measurements were performed in a series of controls.
Results:
Fifteen patients with BE and 13 control patients were studied. Two patients had focal submucosal thickening on EUS with EWTs of 10 mm and 7 mm. Surgical resection of the esophagus in these two cases with high-grade dysplasia revealed submucosal carcinoma at the area of EUS-documented thickening. The mean EWT of controls measured 2.6 mm, nondysplastic BE measured 3.3 mm, and BE with dysplasia measured 4.0 mm. The EWT of both dysplastic and nondysplastic Barrett's was significantly greater than that of the controls (p < 0.02, Student's t test).
Conclusions:
1) As measured by EUS, the esophageal wall is significantly thickened in the columnar-lined portion of Barrett's esophagus. 2) EUS-detected focal thickening may represent submucosal carcinoma in areas of dysplasia and guide early surgery. Thus, EUS may play a role in evaluating the patients with dysplasia in Barrett's esophagus.