Skip to main content
Log in

Recent Advances in Non-invasive Esophageal Tissue Sampling

  • Esophagus (J Clarke and N Ahuja, Section Editors)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 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.

    Article  PubMed  Google Scholar 

  2. El-Serag HB, Petersen NJ, Carter J, et al. Gastroesophageal reflux among different racial groups in the United States. Gastroenterology. 2004;126:1692–9.

    Article  PubMed  Google Scholar 

  3. 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. 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. 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.

    Article  CAS  PubMed  Google Scholar 

  6. 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  Google Scholar 

  7. 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.

    Article  CAS  PubMed  Google Scholar 

  8. •• 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.

    Article  PubMed  Google Scholar 

  9. 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. Sharma P, Brill J, Canto M, et al. White Paper AGA: advanced imaging in Barrett’s esophagus. Clin Gastroenterol Hepatol. 2015;13:2209–18.

    Article  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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. 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.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  CAS  PubMed  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. 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. 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.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. 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.

    Article  CAS  PubMed  Google Scholar 

  23. di Pietro M, Chan D, Fitzgerald RC, et al. Screening for Barrett’s esophagus. Gastroenterology. 2015;148:912–23.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 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.

    CAS  PubMed  Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gupta M, Beebe TJ, Dunagan KT, et al. Screening for Barrett’s esophagus: results from a population-based survey. Dig Dis Sci. 2014;59:1831–50.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Waterman M, Gralnek IM. Capsule endoscopy of the esophagus. J Clin Gastroenterol. 2009;43:605–12.

    Article  PubMed  Google Scholar 

  29. 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.

    Article  PubMed  Google Scholar 

  30. 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.

    Article  CAS  PubMed  Google Scholar 

  31. • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  32. 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. 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. 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.

    Article  CAS  PubMed  Google Scholar 

  35. 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.

    Article  CAS  PubMed  Google Scholar 

  36. 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.

    Article  PubMed  Google Scholar 

  37. 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.

    Article  CAS  PubMed  Google Scholar 

  38. •• 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.

    Article  PubMed  Google Scholar 

  39. 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.

    Article  PubMed  Google Scholar 

  40. 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. 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.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to David A. Katzka.

Additional information

This article is part of the Topical Collection on Esophagus

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Katzka, D.A. Recent Advances in Non-invasive Esophageal Tissue Sampling. Curr Gastroenterol Rep 19, 9 (2017). https://doi.org/10.1007/s11894-017-0550-4

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11894-017-0550-4

Keywords

Navigation