Safety of A Systematic Endoscopic Biopsy Protocol in... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

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Safety of A Systematic Endoscopic Biopsy Protocol in Patients With Barrett's Esophagus

Levine, Douglas S MD1; Blount, Patricia L MD1,2,3; Rudolph, Rebecca E MD, MPH2,3; Reid, Brian J MD, PhD1,2,3,4,5

1_Department of Medicine (Gastroenterology Division), University of Washington, Seattle, Washington, USA_

4Department of Genetics, University of Washington, Seattle, Washington, USA

2Program in GI Oncology, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA

3Division of Public Health Sciences Fred Hutchinson Cancer Research Center, Seattle, Washington, USA

5Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA

Reprint requests and correspondence: Douglas S Levine, MD, FACG, AstraZeneca LP, 725 Chesterbrook Boulevard, E-2C, Wayne, PA 19087-5677.

Received 28 April 1999; accepted 07 January 2000

Abstract

OBJECTIVE:

Widespread implementation of rigorous, systematic endoscopic biopsy protocols for patients with Barrett's esophagus may be hindered by concerns about their safety. This report describes the safety experience of a large series of patients with gastroesophageal reflux disease and Barrett's esophagus who underwent such procedures.

METHODS:

Patients in the Seattle Barrett's Esophagus Project undergo biopsy surveillance in a research-based clinical setting, using large channel endoscopes and “jumbo” biopsy forceps. After visual inspection, multiple biopsies are obtained from lesions and at 1- to 2-cm intervals throughout the Barrett's esophageal segment.

RESULTS:

From 1983 to 1997, 1,458 consecutive endoscopies were performed on 705 patients and 50,833 biopsies (average, 35; maximum, 120 per procedure) were taken. Procedures lasted from 15 to 90 min during which one to two biopsies were obtained per minute. Eleven patients experienced 18 significant adverse events, five of which led to overnight hospitalizations: two for bleeding attributed to concomitant esophageal stricture dilation; two for cardiac dysrhythmias; and one for respiratory arrest. Events managed in outpatient settings included chest pain during seven endoscopies (all accounted for by two patients), chest or epigastric pain developing after five endoscopies, and one tonsillar abrasion. All patients recovered completely, and no deaths, perforations, aspiration, or esophageal stricturing resulted from the procedures.

CONCLUSIONS:

A rigorous, systematic endoscopic biopsy protocol in patients with Barrett's esophagus does not produce esophageal perforation or bleeding when performed by an experienced team of physicians, nurses, and technicians.