Clin Endosc.  2014 Jan;47(1):47-54.

Advanced Imaging Technologies for the Detection of Dysplasia and Early Cancer in Barrett Esophagus

• Espino A
• Cirocco M
• DaCosta R
• Marcon N

Abstract

Advanced esophageal adenocarcinomas arising from Barrett esophagus (BE) are tumors with an increasing incidence and poor prognosis. The aim of endoscopic surveillance of BE is to detect dysplasia, particularly high-grade dysplasia and intramucosal cancers that can subsequently be treated endoscopically before progression to invasive cancer with lymph node metastases. Current surveillance practice standards require the collection of random 4-quadrant biopsy specimens over every 1 to 2 cm of BE (Seattle protocol) to detect dysplasia with the assistance of white light endoscopy, in addition to performing targeted biopsies of recognizable lesions. This approach is labor-intensive but should currently be considered state of the art. Chromoendoscopy, virtual chromoendoscopy (e.g., narrow band imaging), and confocal laser endomicroscopy, in addition to high-definition standard endoscopy, might increase the diagnostic yield for the detection of dysplastic lesions. Until these modalities have been demonstrated to enhance efficiency or cost effectiveness, the standard protocol will remain careful examination using conventional off the shelf high-resolution endoscopes, combined with as longer inspection time which is associated with increased detection of dysplasia.

Keyword

Barrett esophagus; Esophageal adenocarcinoma; Advanced imaging

MeSH Terms

Adenocarcinoma
Barrett Esophagus*
Biopsy
Cost-Benefit Analysis
Endoscopes
Endoscopy
Incidence
Lymph Nodes
Neoplasm Metastasis
Prognosis

Figure

• 

  Fig. 1 (A) White light image of Barrett esophagus C5M7. (B) Corresponding narrow band imaging Barrett esophagus image showing the regular villous architecture.

• 

  Fig. 2 (A) White light image of slightly raised irregular mucosa. (B) Corresponding narrow band image showing a disruptive pit pattern; histology indicated intramucosal cancer involving the lamina propria (M1).

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