Risk for Dysplastic or Neoplastic Progression of Irregular Z Line

Prospectively collected data support current guideline recommendations to forego biopsy in patients with an irregular Z line.

Current national guidelines recommend against esophageal biopsy for assessment of precancerous Barrett esophagus (BE) in patients with an irregular Z line, i.e., <1 cm of irregular mucosa (NEJM JW Gastroenterol Feb 2016 and Am J Gastroenterol 2016; 111:30).

In a continuation of a prospective cohort study, researchers evaluated histologic progression in 102 patients identified with an irregular Z line (defined as <5 mm) during baseline endoscopy with biopsy. Fifty patients had intestinal metaplasia (IM) at baseline and 52 did not. All pathological analyses were performed by a dedicated expert.

At follow-up endoscopy (mean time since baseline endoscopy, 70 months; range, 37–94 months), BE was evident in 16% of IM-positive patients and 2% of IM-…

Reviewing Author

David A. Johnson, MD

Disclosures

Consultant/Advisory boardMedscape/WebMD; Pfizer; CRH Medical Corporation; Aries

EquityCRH Medical Corporation

Editorial boardsMedscape Gastroenterology

Leadership positions in professional societiesAmerican College of Gastroenterology Research Institute Board of Directors