Endoscopy 2008; 40(11): 883-887
DOI: 10.1055/s-2008-1077678
Original article

© Georg Thieme Verlag KG Stuttgart · New York

“Dry biopsies” with spraying of dilute epinephrine optimize biopsy mapping of long segment Barrett’s esophagus

J.  Pohl1 , M.  Nguyen-Tat1 , H.  Manner1 , O.  Pech1 , S.  J.  B.  van Weyenberg2 , C.  Ell1
  • 1Department of Gastroenterology, Dr. Horst Schmidt Klinik, Wiesbaden, (Medical School of the University of Mainz), Germany
  • 2Department of Gastroenterology , VU University Medical Centre, Amsterdam, The Netherlands
Further Information

Publication History

submitted 27 June 2008

accepted after revision 8 September 2008

Publication Date:
02 October 2008 (online)

Background and study aims: For surveillance of Barrett’s esophagus random stepwise four-quadrant biopsy (4QB) is recommended for detecting macroscopically occult neoplasias. Thorough performance of the systematic protocol is commonly hampered by poor visibility due to oozing from biopsy sites. Topical application of dilute epinephrine may prevent bleeding by vasoconstriction of superficial microvessels and might therefore enable ”dry biopsy” sampling. The aim of this study was to examine the safety and efficacy of spraying dilute epinephrine for optimal 4QB mapping of Barrett’s esophagus.

Patients and methods: In this prospective, double-blind trial 40 patients with known long segment Barrett’s esophagus were randomly allocated to undergo spraying with either dilute epinephrine (1 : 20 000) (epinephrine group; n = 20) or saline (control group; n = 20) before 4QB sampling. During endoscopies patients received continuous monitoring of vital parameters. Endoscopists blinded to randomization assessed visibility scores during biopsy sampling. Additionally, electronically stored images of the Barrett’s esophagus segment after 4QB sampling were evaluated by blinded assessors.

Results: The mean length of Barrett’s segments was 5.5 ± 1.8 cm and the mean number of 4QBs was 12.5 ± 3.6 with no statistically significant differences between control and epinephrine groups. Epinephrine spraying did not affect patients’ vital parameters. Visualization ratings by endoscopists on site and by the assessors of the stored images were significantly better in the epinephrine compared with the control group (P < 0.05). Moreover, epinephrine spraying reduced the time for 4QB sampling (P = 0.015) and the mean number of saline flushes needed to maintain visibility (P = 0.0003).

Conclusions: The novel “dry biopsy” technique with spraying of dilute epinephrine is safe, and facilitates thorough performance of systematic 4QB mapping of Barrett’s esophagus by improvement of visibility.

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J. PohlMD, PhD 

Department of Internal Medicine II
Dr. Horst Schmidt-Klinik

Ludwig-Erhard-Str. 100
Wiesbaden
Germany

Fax: +49-611-432418

Email: pohljuergen@web.de

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