In-Office Unsedated Esophagoscopy
High-resolution transnasal esophagoscopy (TNE) is a new diagnostic technology that allows comprehensive, in-office, unsedated examination of the esophagus. The use of the EndoCDx brush biopsy during transnasal endoscopy increases the tissue area sampled and therefore, increases the yield of patients identified with abnormality.
Unlike standard cytology brushes that are typically soft and primarily designed to gently remove spontaneously exfoliated squamous cells, the EndoCDx biopsy brush is specifically designed to consistently sample all of layers deeper layers of the more firmly attached glandular epithelium found in Barrett’s esophagus.
In addition, the analysis of brush biopsy specimens is aided by a high speed computer scan which identifies potentially abnormal cells on a high resolution video monitor for specially trained pathologists to review. This results in diagnoses with high interobserver reliability.
"The brush biopsy allows Otalaryngologists to evaluate the esophagus for Barrett's Disease and dysplasia while the patient is undergoing TNE"
- Milan Amin, MD
In recently published large clinical trials, EndoCDx has been demonstrated to significantly increase the detection of Barrett's esophagus and esophageal dysplasia (1-2). The use of the brush biopsy for the early detection of esophageal dysplasia and carcinoma can potentially result in improving the poor survival rate associated with esophageal adenocarcinoma.
Transepithelial Brush Biopsy Overview
EndoCDx Brush Biopsy Technique is Simple
With the esophagus intubated and the esophageal mucosa clearly visualized, a brush biopsy of the suspected area and/or squamocolumnar junction should be obtained.
The brush tip is retracted into its surrounding sheath and the brush passed down the biopsy channel. The brush tip should be advanced and placed against the surface of the mucosa. While maintaining firm pressure, the brush tip should be rotated and repeatedly passed back and forth over the abnormality and/or squamocolumnar junction until pinpoint bleeding is observed.
Once the sample is collected, the brush tip is again retracted into the surrounding sheath and the brush removed from channel. The cellular material is spread from the brush onto the bar-coded side of the enclosed glass slide. The bristle portion of brush is clipped off into the enclosed vial. The sample is then sent to the CDx for processing and analysis.
Full Transepithelial Sample
Images of abnormal cells detected by the EndoCDx brush biopsy from patients who were cup forceps biopsy negative for both Barrett’s and Dysplasia.
A specimen smear and cellblock are prepared from the sample and analyzed with the aid of a proprietary high speed computer which localizes potentially abnormal cells and cell clusters through a combined morphological, molecular and DNA ploidy analysis. Potentially abnormal cells and cell clusters are selected by the computer for examination on a high resolution video monitor by a specially trained pathologist who makes the final diagnosis.
Benefits of the EndoCDx Brush Biopsy
High-resolution transnasal esophagoscopy coupled with a brush biopsy of the GE junction allows comprehensive, in-office examination of the esophagus without sedation.
- No need for general anesthesia
- Achieves a complete wide area, transepithelial tissue sample
- Decreases sampling errors inherent in random, forceps biopsies of the esophagus
- Analysis of EndoCDx specimens is aided by a high speed computer scan which identifies potentially abnormal cells, cell clusters and abnormal glandular cells
- Increasing detection of esophageal dysplasia and carcinoma can potentially in improve the poor survival rate associated with esophageal adenocarcinoma.