Effects of dropping the requirement for goblet cells from the diagnosis of Barrett's esophagus.

BACKGROUND & AIMS: The 2011 American Gastroenterological Association diagnostic criteria for Barrett's esophagus (BE) require the presence of goblet cells in biopsy specimens of columnar mucosa within the esophagus. In other countries, patients can be diagnosed with BE based on evidence of columnar epithelium, regardless of the presence of goblet cells. We examined the effects that a broader criteria would have on diagnoses of patients with endoscopically suspected BE. We also compared the clinical outcomes of patients with and without goblet cells in esophageal biopsy samples. METHODS: We analyzed the University of Chicago Medical Center database to identify 690 patients with no previous history of BE who underwent endoscopic biopsy analysis for BE from 1987 to 2008. We collected endoscopy reports, histology results, and chart reviews. RESULTS: Of biopsy specimens analyzed, samples from 258 patients contained goblet cells and 379 did not (53 of the biopsy samples contained only squamous mucosa). Patients whose biopsy samples contained goblet cells had longer endoscopic columnar segments (mean, 4.6 cm) and more biopsy specimens taken (mean, 5 biopsy specimens) than those without (mean length, 1.6 cm; mean, 4 biopsy specimens). Of patients whose biopsy specimens did not contain goblet cells, 35% underwent additional endoscopy; goblet cells continued to be absent in 88% of these (mean follow-up time, 5.8 y; 2.8 additional procedures; mean total biopsy specimens, 12). Goblet cells were identified in only 19% of all patients with columnar mucosa less than 2 cm. No patient without goblet cells developed adenocarcinoma. CONCLUSIONS: Decreasing the requirement for goblet cells would increase the diagnosis of BE by 147%. Among patients with short columnar segments, subsequent endoscopy generally does not reveal goblet cells, so the columnar mucosa might represent proximal stomach. Decreasing the requirement for goblet cells would cause many patients to be inaccurately labeled as BE.

CD61, CD31, and CD34 improve diagnostic accuracy in gastric antral vascular ectasia and portal hypertensive gastropathy: An immunohistochemical and digital morphometric study.

Portal hypertensive gastropathy (PHG) and gastric antral vascular ectasia (GAVE) are unusual but important causes of gastrointestinal bleeding with characteristic endoscopic appearances and critically different therapies. However, overlapping features and poor endoscopic-histologic correlation make their distinction challenging. We sought to determine whether CD31, CD34 (vascular markers), and CD61 (platelet marker) could aid in their differentiation. Cases included 11 antral specimens with histologic diagnoses of GAVE, 11 histologically diagnosed as PHG, and biopsies of GAVE (15) or PHG (12) suspected on endoscopy but without histologic agreement. Controls consisted of endoscopically and histologically normal antrum. Image analysis of CD31 and CD34-stained sections was performed to determine mucosal microvessel density (MVD). CD61 revealed thrombi in 100% of histologically confirmed cases of GAVE and 60% of cases suspected of GAVE on endoscopy alone; control biopsies were negative. CD61 was also positive in 26% of cases originally signed out as PHG. Review of hematoxylin and eosin slides from these CD61-positive PHG cases showed other features allowing their correct reclassification as GAVE. MVD was significantly higher in GAVE than PHG. MVD in histologically confirmed PHG did not differ significantly from endoscopically suspected PHG. Review of hematoxylin and eosin slides from the latter showed active gastritis obscuring recognition of ectatic vessels. In conclusion, CD61 reliably differentiates GAVE from PHG. MVD analysis can also assist in their distinction. In PHG, the increased vascularity may be subtle in an inflammatory background; vascular markers may serve as adjunct markers for identifying the aberrant vessels.