Analysis of the Yield of Intestinal Metaplasia Based on Biopsy Numbers and Follow-Up Endoscopy in a Large Series of Asian Patients With Barrett's Esophagus

Objectives: Intestinal metaplasia (IM) is a premalignant lesion within the columnar-lined esophagus (CLE). The detection of IM stratifies the risk of cancer progression. We aim to investigate the random biopsy yield of IM in Asian patients with CLE. Methods: A total of 117,526 consecutive esophagogastroduodenoscopies (EGDs) in the outpatient setting were retrospectively screened. The histopathological findings independently reviewed by two pathologists were correlated with the clinical and endoscopic features and the number of biopsies. Results: Among 5963 EGDs, 3135 patients (5.1%) were diagnosed with CLE. A total of 4675 EGDs involving 8994 biopsies (median = 1, range 1–9) exhibited a 35.1% yield of IM per endoscopy. The yield of IM was higher in cases of long-segment CLE (74.8%) compared with short-segment (32.9%). IM detection was significantly associated with male gender (odds ratio, 95% confidence interval = 1.58, 1.37–1.83), chronological age (1.02, 1.02–1.03), longer segment CLE (1.75, 1.58–1.94), and number of biopsies per endoscopy (1.40, 1.32–1.49). One biopsy during each EGD resulted in a 26% IM yield, which was significantly lower than the yields after three biopsies (2.85, 2.25–3.62) and after following the Seattle protocol (2.86, 2.34–3.50). In 1772 patients without IM on index endoscopy, subsequent endoscopies increased the IM detection rate by 6%, with 4% attributed to the second endoscopy and 2% to the third through eighth endoscopy. Conclusions: This study provides insights into the number of biopsies needed to characterize IM in Barrett's esophagus. Further research is needed to optimize biopsy strategies, particularly in Asian countries.