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Published in: Current Gastroenterology Reports 3/2017

01-03-2017 | Esophagus (J Clarke and N Ahuja, Section Editors)

Recent Advances in Non-invasive Esophageal Tissue Sampling

Author: David A. Katzka

Published in: Current Gastroenterology Reports | Issue 3/2017

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Abstract

Purpose of Review

The costs to society and accuracy of screening for esophageal cancer and other esophageal diseases with standard endoscopy are formidable. As a result, the applicability of endoscopy as a general screening tool has been challenged.

Recent Findings

To maintain accuracy but reduce the price of endoscopy on society, multiple adjunct or replacement technologies are being developed that are less expensive and more easily applied. These devices include image-enhancing techniques that more reliably identify dysplasia and cancer reducing the need for extensive biopsy sampling during standard endoscopy. They also include ambulatory forms for procuring esophageal imaging including smaller endoscopes and capsule endoscopy. Finally, some of the newer methods either obtain samples of esophageal tissue through bedside maneuvers not requiring endoscopy or retrieve information about mucosal inflammation and function without the need to procure esophageal tissue.

Summary

There is an exciting future for esophageal diagnosis with tools that will save cost and/or provide greater accuracy and safety for some of the most common esophageal disorders.
Literature
1.
go back to reference Locke 3rd GR, Talley NJ, Fett SL, et al. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology. 1997;112:1448–56.CrossRefPubMed Locke 3rd GR, Talley NJ, Fett SL, et al. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology. 1997;112:1448–56.CrossRefPubMed
2.
go back to reference El-Serag HB, Petersen NJ, Carter J, et al. Gastroesophageal reflux among different racial groups in the United States. Gastroenterology. 2004;126:1692–9.CrossRefPubMed El-Serag HB, Petersen NJ, Carter J, et al. Gastroesophageal reflux among different racial groups in the United States. Gastroenterology. 2004;126:1692–9.CrossRefPubMed
3.
go back to reference Dellon ES, Jensen ET, Martin CF, et al. Prevalence of eosinophilic esophagitis in the United States. Clin Gastroenterol Hepatol. 2014;12:589-96 e1. Dellon ES, Jensen ET, Martin CF, et al. Prevalence of eosinophilic esophagitis in the United States. Clin Gastroenterol Hepatol. 2014;12:589-96 e1.
4.
go back to reference Peery AF, Crockett SD, Barritt AS, et al. Burden of Gastrointestinal, Liver, and Pancreatic Diseases in the United States. Gastroenterology. 2015;149:1731-1741 e3. Peery AF, Crockett SD, Barritt AS, et al. Burden of Gastrointestinal, Liver, and Pancreatic Diseases in the United States. Gastroenterology. 2015;149:1731-1741 e3.
5.
go back to reference Jayasekera C, Taylor AC, Desmond PV, et al. Added value of narrow band imaging and confocal laser endomicroscopy in detecting Barrett’s esophagus neoplasia. Endoscopy. 2012;44:1089–95.CrossRefPubMed Jayasekera C, Taylor AC, Desmond PV, et al. Added value of narrow band imaging and confocal laser endomicroscopy in detecting Barrett’s esophagus neoplasia. Endoscopy. 2012;44:1089–95.CrossRefPubMed
6.
go back to reference Singh R, Jayanna M, Wong J, et al. Narrow-band imaging and white-light endoscopy with optical magnification in the diagnosis of dysplasia in Barrett’s esophagus: results of the Asia-Pacific Barrett’s Consortium. Endosc Int Open. 2015;3:E14–8.PubMed Singh R, Jayanna M, Wong J, et al. Narrow-band imaging and white-light endoscopy with optical magnification in the diagnosis of dysplasia in Barrett’s esophagus: results of the Asia-Pacific Barrett’s Consortium. Endosc Int Open. 2015;3:E14–8.PubMed
7.
go back to reference Song J, Zhang J, Wang J, et al. Meta-analysis of the effects of endoscopy with narrow band imaging in detecting dysplasia in Barrett’s esophagus. Dis Esophagus. 2015;28:560–6.CrossRefPubMed Song J, Zhang J, Wang J, et al. Meta-analysis of the effects of endoscopy with narrow band imaging in detecting dysplasia in Barrett’s esophagus. Dis Esophagus. 2015;28:560–6.CrossRefPubMed
8.
go back to reference •• Sharma P, Bergman JJ, Goda K, et al. Development and Validation of a Classification System to Identify High-Grade Dysplasia and Esophageal Adenocarcinoma in Barrett’s Esophagus Using Narrow-Band Imaging. Gastroenterology. 2016;150:591–8. This study performed by experts in Barrett’s esophagus and narrow band imaging provides a compelling simple, internally validated system to identify dysplasia and EAC in patients with BE based on NBI results.CrossRefPubMed •• Sharma P, Bergman JJ, Goda K, et al. Development and Validation of a Classification System to Identify High-Grade Dysplasia and Esophageal Adenocarcinoma in Barrett’s Esophagus Using Narrow-Band Imaging. Gastroenterology. 2016;150:591–8. This study performed by experts in Barrett’s esophagus and narrow band imaging provides a compelling simple, internally validated system to identify dysplasia and EAC in patients with BE based on NBI results.CrossRefPubMed
9.
go back to reference Thosani N, Abu Dayyeh BK, Sharma P, et al. ASGE Technology Committee systematic review and meta-analysis assessing the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations thresholds for adopting real-time imaging-assisted endoscopic targeted biopsy during endoscopic surveillance of Barrett’s esophagus. Gastrointest Endosc. 2016;83:684-98 e7. Thosani N, Abu Dayyeh BK, Sharma P, et al. ASGE Technology Committee systematic review and meta-analysis assessing the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations thresholds for adopting real-time imaging-assisted endoscopic targeted biopsy during endoscopic surveillance of Barrett’s esophagus. Gastrointest Endosc. 2016;83:684-98 e7.
10.
go back to reference Sharma P, Brill J, Canto M, et al. White Paper AGA: advanced imaging in Barrett’s esophagus. Clin Gastroenterol Hepatol. 2015;13:2209–18.CrossRefPubMed Sharma P, Brill J, Canto M, et al. White Paper AGA: advanced imaging in Barrett’s esophagus. Clin Gastroenterol Hepatol. 2015;13:2209–18.CrossRefPubMed
11.
go back to reference di Pietro M, Bird-Lieberman EL, Liu X, et al. Autofluorescence-directed confocal endomicroscopy in combination with a three-biomarker panel can inform management decisions in Barrett’s esophagus. Am J Gastroenterol. 2015;110:1549–58.CrossRefPubMed di Pietro M, Bird-Lieberman EL, Liu X, et al. Autofluorescence-directed confocal endomicroscopy in combination with a three-biomarker panel can inform management decisions in Barrett’s esophagus. Am J Gastroenterol. 2015;110:1549–58.CrossRefPubMed
12.
go back to reference Gong EJ, Kim DH, Ahn JY, et al. Routine endoscopic screening for synchronous esophageal neoplasm in patients with head and neck squamous cell carcinoma: a prospective study. Dis Esophagus. 2016. doi:10.1111/dote.12404. Gong EJ, Kim DH, Ahn JY, et al. Routine endoscopic screening for synchronous esophageal neoplasm in patients with head and neck squamous cell carcinoma: a prospective study. Dis Esophagus. 2016. doi:10.​1111/​dote.​12404.
13.
go back to reference Carvalho R, Areia M, Brito D, et al. Diagnostic accuracy of lugol chromoendoscopy in the oesophagus in patients with head and neck cancer. Rev Esp Enferm Dig. 2013;105:79–83.CrossRefPubMed Carvalho R, Areia M, Brito D, et al. Diagnostic accuracy of lugol chromoendoscopy in the oesophagus in patients with head and neck cancer. Rev Esp Enferm Dig. 2013;105:79–83.CrossRefPubMed
14.
go back to reference Hori K, Okada H, Kawahara Y, et al. Lugol-voiding lesions are an important risk factor for a second primary squamous cell carcinoma in patients with esosphageal cancer or head and neck cancer. Am J Gastroenterol. 2011;106:858–66.CrossRefPubMed Hori K, Okada H, Kawahara Y, et al. Lugol-voiding lesions are an important risk factor for a second primary squamous cell carcinoma in patients with esosphageal cancer or head and neck cancer. Am J Gastroenterol. 2011;106:858–66.CrossRefPubMed
15.
go back to reference Chung CS, Lo WC, Lee YC, et al. Image-enhanced endoscopy for detection of second primary neoplasm in patients with esophageal and head and neck cancer: a systematic review and meta-analysis. Head Neck. 2016;38 Suppl 1:E2343–9.CrossRefPubMed Chung CS, Lo WC, Lee YC, et al. Image-enhanced endoscopy for detection of second primary neoplasm in patients with esophageal and head and neck cancer: a systematic review and meta-analysis. Head Neck. 2016;38 Suppl 1:E2343–9.CrossRefPubMed
16.
go back to reference Lecleire S, Antonietti M, Iwanicki-Caron I, et al. Lugol chromo-endoscopy versus narrow band imaging for endoscopic screening of esophageal squamous-cell carcinoma in patients with a history of cured esophageal cancer: a feasibility study. Dis Esophagus. 2011;24:418–22.CrossRefPubMed Lecleire S, Antonietti M, Iwanicki-Caron I, et al. Lugol chromo-endoscopy versus narrow band imaging for endoscopic screening of esophageal squamous-cell carcinoma in patients with a history of cured esophageal cancer: a feasibility study. Dis Esophagus. 2011;24:418–22.CrossRefPubMed
17.
go back to reference Sami SS, Dunagan KT, Johnson ML, et al. A randomized comparative effectiveness trial of novel endoscopic techniques and approaches for Barrett’s esophagus screening in the community. Am J Gastroenterol. 2015;110:148–58.CrossRefPubMed Sami SS, Dunagan KT, Johnson ML, et al. A randomized comparative effectiveness trial of novel endoscopic techniques and approaches for Barrett’s esophagus screening in the community. Am J Gastroenterol. 2015;110:148–58.CrossRefPubMed
18.
go back to reference Peery AF, Hoppo T, Garman KS, et al. Feasibility, safety, acceptability, and yield of office-based, screening transnasal esophagoscopy (with video). Gastrointest Endosc. 2012;75:945-953 e2. Peery AF, Hoppo T, Garman KS, et al. Feasibility, safety, acceptability, and yield of office-based, screening transnasal esophagoscopy (with video). Gastrointest Endosc. 2012;75:945-953 e2.
19.
go back to reference Crews NR, Johnson ML, Schleck CD, et al. Prevalence and predictors of gastroesophageal reflux complications in community subjects. Dig Dis Sci. 2016;61(11):3221–8.CrossRefPubMed Crews NR, Johnson ML, Schleck CD, et al. Prevalence and predictors of gastroesophageal reflux complications in community subjects. Dig Dis Sci. 2016;61(11):3221–8.CrossRefPubMed
20.
go back to reference Alashkar B, Faulx AL, Hepner A, et al. Development of a program to train physician extenders to perform transnasal esophagoscopy and screen for Barrett’s esophagus. Clin Gastroenterol Hepatol. 2014;12:785–92.CrossRefPubMed Alashkar B, Faulx AL, Hepner A, et al. Development of a program to train physician extenders to perform transnasal esophagoscopy and screen for Barrett’s esophagus. Clin Gastroenterol Hepatol. 2014;12:785–92.CrossRefPubMed
21.
go back to reference Arantes V, Albuquerque W, Salles JM, et al. Effectiveness of unsedated transnasal endoscopy with white-light, flexible spectral imaging color enhancement, and lugol staining for esophageal cancer screening in high-risk patients. J Clin Gastroenterol. 2013;47:314–21.CrossRefPubMed Arantes V, Albuquerque W, Salles JM, et al. Effectiveness of unsedated transnasal endoscopy with white-light, flexible spectral imaging color enhancement, and lugol staining for esophageal cancer screening in high-risk patients. J Clin Gastroenterol. 2013;47:314–21.CrossRefPubMed
22.
go back to reference Wang CH, Lee YC, Wang CP, et al. Use of transnasal endoscopy for screening of esophageal squamous cell carcinoma in high-risk patients: yield rate, completion rate, and safety. Dig Endosc. 2014;26:24–31.CrossRefPubMed Wang CH, Lee YC, Wang CP, et al. Use of transnasal endoscopy for screening of esophageal squamous cell carcinoma in high-risk patients: yield rate, completion rate, and safety. Dig Endosc. 2014;26:24–31.CrossRefPubMed
24.
go back to reference Domingos TA, Moura EG, Mendes DC, et al. Comparative evaluation of esophageal Barrett’s epithelium through esophageal capsule endoscopy and methylene blue chromoendoscopy. Rev Gastroenterol Mex. 2013;78:57–63.PubMed Domingos TA, Moura EG, Mendes DC, et al. Comparative evaluation of esophageal Barrett’s epithelium through esophageal capsule endoscopy and methylene blue chromoendoscopy. Rev Gastroenterol Mex. 2013;78:57–63.PubMed
25.
go back to reference Bhardwaj A, Hollenbeak CS, Pooran N, et al. A meta-analysis of the diagnostic accuracy of esophageal capsule endoscopy for Barrett’s esophagus in patients with gastroesophageal reflux disease. Am J Gastroenterol. 2009;104:1533–9.CrossRefPubMed Bhardwaj A, Hollenbeak CS, Pooran N, et al. A meta-analysis of the diagnostic accuracy of esophageal capsule endoscopy for Barrett’s esophagus in patients with gastroesophageal reflux disease. Am J Gastroenterol. 2009;104:1533–9.CrossRefPubMed
26.
go back to reference Chak A, Alashkar BM, Isenberg GA, et al. Comparative acceptability of transnasal esophagoscopy and esophageal capsule esophagoscopy: a randomized, controlled trial in veterans. Gastrointest Endosc. 2014;80:774–82.CrossRefPubMedPubMedCentral Chak A, Alashkar BM, Isenberg GA, et al. Comparative acceptability of transnasal esophagoscopy and esophageal capsule esophagoscopy: a randomized, controlled trial in veterans. Gastrointest Endosc. 2014;80:774–82.CrossRefPubMedPubMedCentral
27.
28.
go back to reference Waterman M, Gralnek IM. Capsule endoscopy of the esophagus. J Clin Gastroenterol. 2009;43:605–12.CrossRefPubMed Waterman M, Gralnek IM. Capsule endoscopy of the esophagus. J Clin Gastroenterol. 2009;43:605–12.CrossRefPubMed
29.
go back to reference Gora MJ, Sauk JS, Carruth RW, et al. Imaging the upper gastrointestinal tract in unsedated patients using tethered capsule endomicroscopy. Gastroenterology. 2013;145:723–5.CrossRefPubMed Gora MJ, Sauk JS, Carruth RW, et al. Imaging the upper gastrointestinal tract in unsedated patients using tethered capsule endomicroscopy. Gastroenterology. 2013;145:723–5.CrossRefPubMed
30.
go back to reference Chavalitdhamrong D, Chen GC, Roth BE, et al. Esophageal capsule endoscopy for evaluation of patients with chronic gastroesophageal reflux symptoms: findings and its image quality. Dis Esophagus. 2011;24:295–8.CrossRefPubMed Chavalitdhamrong D, Chen GC, Roth BE, et al. Esophageal capsule endoscopy for evaluation of patients with chronic gastroesophageal reflux symptoms: findings and its image quality. Dis Esophagus. 2011;24:295–8.CrossRefPubMed
31.
go back to reference • Ross-Innes CS, Debiram-Beecham I, O’Donovan M, et al. Evaluation of a minimally invasive cell sampling device coupled with assessment of trefoil factor 3 expression for diagnosing Barrett’s esophagus: a multi-center case-control study. PLoS Med. 2015;12:e1001780. This may well be the future in screening for Barrett’s esophagus and adenocarcinoma. It is a simple, safe, accurate, bedside test which can be performed by physicians and physician extenders and avoid the need for screening endoscopy.CrossRefPubMedPubMedCentral • Ross-Innes CS, Debiram-Beecham I, O’Donovan M, et al. Evaluation of a minimally invasive cell sampling device coupled with assessment of trefoil factor 3 expression for diagnosing Barrett’s esophagus: a multi-center case-control study. PLoS Med. 2015;12:e1001780. This may well be the future in screening for Barrett’s esophagus and adenocarcinoma. It is a simple, safe, accurate, bedside test which can be performed by physicians and physician extenders and avoid the need for screening endoscopy.CrossRefPubMedPubMedCentral
32.
go back to reference Benaglia T, Sharples LD, Fitzgerald RC, et al. Health benefits and cost effectiveness of endoscopic and nonendoscopic cytosponge screening for Barrett’s esophagus. Gastroenterol. 2013;144:62-73 e6. Benaglia T, Sharples LD, Fitzgerald RC, et al. Health benefits and cost effectiveness of endoscopic and nonendoscopic cytosponge screening for Barrett’s esophagus. Gastroenterol. 2013;144:62-73 e6.
33.
go back to reference Katzka DA, Geno DM, Ravi A, et al. Accuracy, safety, and tolerability of tissue collection by Cytosponge vs endoscopy for evaluation of eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2015;13:77-83 e2. Katzka DA, Geno DM, Ravi A, et al. Accuracy, safety, and tolerability of tissue collection by Cytosponge vs endoscopy for evaluation of eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2015;13:77-83 e2.
34.
go back to reference Liu SF, Shen Q, Dawsey SM, et al. Esophageal balloon cytology and subsequent risk of esophageal and gastric-cardia cancer in a high-risk Chinese population. Int J Cancer. 1994;57:775–80.CrossRefPubMed Liu SF, Shen Q, Dawsey SM, et al. Esophageal balloon cytology and subsequent risk of esophageal and gastric-cardia cancer in a high-risk Chinese population. Int J Cancer. 1994;57:775–80.CrossRefPubMed
35.
go back to reference Wang LD, Yang HH, Fan ZM, et al. Cytological screening and 15 years’ follow-up (1986-2001) for early esophageal squamous cell carcinoma and precancerous lesions in a high-risk population in Anyang County, Henan Province, Northern China. Cancer Detect Prev. 2005;29:317–22.CrossRefPubMed Wang LD, Yang HH, Fan ZM, et al. Cytological screening and 15 years’ follow-up (1986-2001) for early esophageal squamous cell carcinoma and precancerous lesions in a high-risk population in Anyang County, Henan Province, Northern China. Cancer Detect Prev. 2005;29:317–22.CrossRefPubMed
36.
go back to reference Pan QJ, Roth MJ, Guo HQ, et al. Cytologic detection of esophageal squamous cell carcinoma and its precursor lesions using balloon samplers and liquid-based cytology in asymptomatic adults in Llinxian, China. Acta Cytol. 2008;52:14–23.CrossRefPubMed Pan QJ, Roth MJ, Guo HQ, et al. Cytologic detection of esophageal squamous cell carcinoma and its precursor lesions using balloon samplers and liquid-based cytology in asymptomatic adults in Llinxian, China. Acta Cytol. 2008;52:14–23.CrossRefPubMed
37.
go back to reference Falk GW, Chittajallu R, Goldblum JR, et al. Surveillance of patients with Barrett’s esophagus for dysplasia and cancer with balloon cytology. Gastroenterology. 1997;112:1787–97.CrossRefPubMed Falk GW, Chittajallu R, Goldblum JR, et al. Surveillance of patients with Barrett’s esophagus for dysplasia and cancer with balloon cytology. Gastroenterology. 1997;112:1787–97.CrossRefPubMed
38.
go back to reference •• Ates F, Yuksel ES, Higginbotham T, et al. Mucosal impedance discriminates GERD from non-GERD conditions. Gastroenterology. 2015;148:334–43. This is a fascinating study applying the use of measuring esophageal mucosa impedance to disease. As decreased impedance reflects increased tissue permeability and compromise of the epithelial barrier, several tools to measure esophageal impedance may become an important tool in assessing esophageal inflammatory diseases.CrossRefPubMed •• Ates F, Yuksel ES, Higginbotham T, et al. Mucosal impedance discriminates GERD from non-GERD conditions. Gastroenterology. 2015;148:334–43. This is a fascinating study applying the use of measuring esophageal mucosa impedance to disease. As decreased impedance reflects increased tissue permeability and compromise of the epithelial barrier, several tools to measure esophageal impedance may become an important tool in assessing esophageal inflammatory diseases.CrossRefPubMed
39.
go back to reference Saritas Yuksel E, Higginbotham T, Slaughter JC, et al. Use of direct, endoscopic-guided measurements of mucosal impedance in diagnosis of gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2012;10:1110–6.CrossRefPubMed Saritas Yuksel E, Higginbotham T, Slaughter JC, et al. Use of direct, endoscopic-guided measurements of mucosal impedance in diagnosis of gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2012;10:1110–6.CrossRefPubMed
40.
go back to reference Katzka DA, Ravi K, Geno DM, et al. Endoscopic Mucosal Impedance Measurements Correlate With Eosinophilia and Dilation of Intercellular Spaces in Patients With Eosinophilic Esophagitis. Clin Gastroenterol Hepatol. 2015;13:1242-1248 e1. Katzka DA, Ravi K, Geno DM, et al. Endoscopic Mucosal Impedance Measurements Correlate With Eosinophilia and Dilation of Intercellular Spaces in Patients With Eosinophilic Esophagitis. Clin Gastroenterol Hepatol. 2015;13:1242-1248 e1.
41.
go back to reference van Rhijn BD, Kessing BF, Smout AJ, et al. Oesophageal baseline impedance values are decreased in patients with eosinophilic oesophagitis. United Eur Gastroenterol J. 2013;1:242–8.CrossRef van Rhijn BD, Kessing BF, Smout AJ, et al. Oesophageal baseline impedance values are decreased in patients with eosinophilic oesophagitis. United Eur Gastroenterol J. 2013;1:242–8.CrossRef
Metadata
Title
Recent Advances in Non-invasive Esophageal Tissue Sampling
Author
David A. Katzka
Publication date
01-03-2017
Publisher
Springer US
Published in
Current Gastroenterology Reports / Issue 3/2017
Print ISSN: 1522-8037
Electronic ISSN: 1534-312X
DOI
https://doi.org/10.1007/s11894-017-0550-4

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