Safety of a systematic endoscopic biopsy protocol in patients with Barrett's esophagus

OBJECTIVE: Widespread implementation of rigorous, systematic endoscopic bio psy protocols for patients with Barrett's esophagus may be hindered by conc erns about their safety. This report describes the safety experience of a l arge 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 end oscopes and "jumbo" biopsy forceps. After visual inspection, multiple biops ies are obtained from lesions and at 1- to 2-cm intervals throughout the Ba rrett'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 bi opsies were obtained per minute. Eleven patients experienced 18 significant adverse events, five of which led to overnight hospitalizations: two for b leeding attributed to concomitant esophageal stricture dilation; two for ca rdiac dysrhythmias: and one for respiratory arrest. Events managed In outpa tient settings included chest pain during seven endoscopies (all accounted for by two patients), chest or epigastric pain developing after five endosc opies, and one tonsillar abrasion. All patients recovered completely, and n o 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 bleedin g when performed by an experienced team of physicians, nurses, and technici ans. (C) 2000 by Am. Cell. of Gastroenterology.