Introduction: The apical junction complex between esophageal epithelial cells helps regulate paracellular transit and thus determines barrier structure and function. Impaired epithelial barrier has been hypothesized to predispose to ongoing esophageal inflammation, increasing the risk recurrent intestinal metaplasia (IM) after successful ablative treatment. Intercellular space (IC) dilation measured on transmission electron microscopy (TEM) is a measure of the morphological integrity of the epithelial barrier. We aimed to compare the degree of IC dilation in neo-squamous mucosa using TEM between two matched cohorts: those that experienced recurrent IM after achieving complete remission of IM (CRIM) with RFA and those that did not. Methods: 30 patients from a prospectively-maintained database, who developed recurrent IM were matched on length of the pre-ablation BE segment and pre-treatment histology with 30 patients without recurrent IM. Intercellular space (ICS) size in the suprabasal layer of the squamous epithelium was measured in biopsies taken from the neo-squamous epithelium, using TEM at three time points:1) at time of recurrence in cases and at a matched time point in controls. 2) 9-12 months prior to recurrence/matched time point in controls and 3) 14-17 months prior to recurrence/matched time point in controls. The ICS was compared between cases and controls at these three time points and regression analysis was conducted to assess the association of ICS with risk of recurrence. Results: The baseline characteristics of the cases and controls are shown in Table 1. The mean duration between the time of recurrence and time point 1 was 10.4 months, and 15.8 months between time of recurrence and time point 2. The mean ICS diameter of the neo-squamous epithelium was substantially greater than previously described normal squamous epithelium (0.42-0.5 μm versus 0.27 μm). The mean ICS measurements at all three time points (see Table 2) were higher in recurrent cases than in non-recurrent controls: these differences were however not statistically significant. The adjusted odds ratios for recurrence based on IC space dilatation are shown in Table 3.Table: Table. Baseline characteristics of recurrent BE (Cases) and non-recurrent (controls) patientsTable: Table. Mean intercellular space diameter measured on transmission electron microscopy in BE cases with and without recurrence after CRIM following RFATable: Table. Odds Ratio for Recurrence Based on IC Space DilatationConclusion: Neo-squamous epithelium after RFA induced CRIM is likely a more permeable epithelial barrier than normal squamous epithelium. Additionally the ICS size was higher in patients with recurrent IM compared to those without recurrent IM (preceding recurrence by 14-17 months), suggesting morphological impairment of the epithelial barrier before recurrence. However, this change did not meet statistical significance, possibly due to small sample size. Larger studies are needed to validate this finding.
Background & AimsScreening for Barrett's esophagus (BE) with conventional esophagogastroduodenoscopy (C-EGD) is expensive. We assessed the performance of a clinic-based, single use transnasal capsule endoscope (EG Scan II) for the detection of BE, compared to C-EGD as the reference standard.MethodsWe performed a prospective multicenter cohort study of patients with and without BE recruited from 3 referral centers (1 in the United States and 2 in the United Kingdom). Of 200 consenting participants, 178 (89%) completed both procedures (11% failed EG Scan due to the inability to intubate the nasopharynx). The mean age of participants was 57.9 years and 67% were male. The prevalence of BE was 53%. All subjects underwent the 2 procedures on the same day, performed by blinded endoscopists. Patients completed preference and validated tolerability (10-point visual analogue scale [VAS]) questionnaires within 14 days of the procedures.ResultsA higher proportion of patients preferred the EG Scan (54.2%) vs the C-EGD (16.7%) (P < .001) and the EG Scan had a higher VAS score (7.2) vs the C-EGD (6.4) (P = .0004). No serious adverse events occurred. The EG Scan identified any length BE with a sensitivity value of 0.90 (95% CI, 0.83–0.96) and a specificity value of 0.91 (95% CI, 0.82–0.96). The EG Scan identified long segment BE with a sensitivity value of 0.95 and short segment BE with a sensitivity values of 0.87.ConclusionsIn a prospective study, we found the EG Scan to be safe and to detect BE with higher than 90% sensitivity and specificity. A higher proportion of patients preferred the EG Scan to C-EGD. This device might be used as a clinic-based tool to screen populations at risk for BE. ISRCTN registry identifier: 70595405; ClinicalTrials.gov no: NCT02066233.
