MOHAMMAD FARIVAR and JAMES KOLTON, DEPT of MEDICINE and DEPT of PATHOLOGY, NORWOOD HOSPITAL, NORWOOD, MA

We have studied a series of esophageal pinch biopsies to assess the ability to perform morphometry of basal zone thickness (BZT) and papillary height (PH) and compared the measurements with visual histopathologic diagnosis of reflux esophagitis. Four biopsy fragments obtained at 2 to 4 cm. Proximal to the GE junction in 176 non-Barrett esophagus patients undergoing endoscopy for various UGI symptoms were routinely processed and diagnosed by various pathologists prior to morphometric assessment. The BZT and PH were measured according to previously Published protocols.

Results: Morphometry could he Performed in 155 (88%) of the cases: 55% were measured in two or more Fragments. Using the usually accepted criteria of BZT > 1/6 (one sixth) and PH > 1/2 (one half) of total mucosal thickness in reflux esophagitis, we found that the biopsies in 28 cases were morphometrically normal. Of these, 8 had histopathologic diagnosis of normal; 11 had non-specific diagnoses: e.g. chronic inflammation, basal cell hyperplasia, and 9 were signed out as chronic esophagitis. Of the 29 cases with the histopathologic diagnosis of normal, 21 had morphometric evidence of reflux esophagitis.

Conclusions: Morphometry of endoscopic esophageal pinch biopsies for BZT and PH can be performed in a majority of cases when four biopsy fragments are obtained; and these measurements can increase the sensitivity of the histopathologic diagnosis of reflux esophagitis and should be performed, especially on apparently normal specimens.