Clin Endosc.  2017 Jan;50(1):81-86. 10.5946/ce.2016.027.

Laser Imaging Facilitates Early Detection of Synchronous Adenocarcinomas in Patients with Barrett's Esophagus

• Iwashita C
• Miura Y
• Osawa H
• Takezawa T
• Ino Y
• Okada M
• Lefor AK
• Yamamoto H

• KMID: 2383495
• DOI: http://doi.org/10.5946/ce.2016.027

Abstract

Barrett's adenocarcinoma may occur in multiple sites, and recurrence and metachronous lesions are the major problems with endoscopic resection. Therefore, early detection of such lesions is ideal to achieve complete resection and obtain improved survival rates with minimally invasive treatment. Laser imaging systems allow multiple modalities of endoscopic imaging by using white light laser, flexible spectral imaging color enhancement (FICE), blue laser imaging (BLI), and linked color imaging even at a distant view. However, the usefulness of these modalities has not been sufficiently reported regarding Barrett's adenocarcinoma. Here, we report on a patient with three synchronous lesions followed by one metachronous lesion in a long segment with changes of Barrett's esophagus, all diagnosed with this new laser endoscopic imaging system and enhanced by using FICE and/or BLI with high contrast compared with the surrounding mucosa. Laser endoscopic imaging may facilitate the detection of malignancies in patients with early Barrett's adenocarcinoma.

Keyword

Barrett esophagus; Early synchronous neoplasms; Endoscopic submucosal dissection; Blue laser imaging; Flexible spectral image color enhancement

MeSH Terms

Adenocarcinoma*
Barrett Esophagus*
Humans
Mucous Membrane
Recurrence
Survival Rate

Figure

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  Fig. 1. (A) Two reddish lesions (white and black arrowheads) are seen in the distal esophagus. (B) Flexible spectral imaging color enhancement shows both lesions that feature depressed-type cancers. The most distal lesion shows inflammatory changes. (C) Markings are placed 5 mm outside each of the two cancers. (D) Malignant lesions were resected with endoscopic submucosal dissection (ESD). (E) Specimens resected from the anterior wall by using ESD are shown. (F) Similarly, specimens from the posterior wall resected with ESD are shown. (G) Resected specimens from the anterior wall show well-differentiated adenocarcinoma (H&E stain, ×100). (H) Similarly, specimens from the posterior wall show well-differentiated adenocarcinoma (H&E stain, ×100).

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  Fig. 2. (A) A slightly reddish lesion is seen in the middle esophagus; however, it is difficult to establish the diagnosis. (B) Flexible spectral imaging color enhancement shows a reddish depressed lesion distinct from the surrounding mucosa. (C) Magnified blue laser imaging shows a brown malignant lesion with an irregular surface pattern distinct from the surrounding mucosa and an irregular vascular pattern in one portion of the tumor. (D) Malignant lesion was resected with endoscopic submucosal dissection (ESD). (E) Specimens resected by using ESD are shown. (F) Pathological evaluation of the resected specimen shows well-differentiated adenocarcinoma (H&E stain, ×100).

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  Fig. 3. (A) A slightly elevated lesion with an irregular surface (white arrowheads) is seen in the middle esophagus; however, it is difficult to establish the diagnosis. (B) Flexible spectral imaging color enhancement shows a slightly brown lesion distinct from the surrounding mucosa. (C) Low-magnification blue laser imaging shows an irregular surface pattern of the elevated malignant lesion distinct from the surrounding mucosa. (D) Half-magnification blue laser imaging more clearly shows the irregular surface pattern of a malignant lesion. (E) Biopsy specimen shows atypical glands suggesting cancer (H&E stain, ×100). (F) Immunohistochemical staining reveals Ki-67-positive cells mainly confined to the surface layer of the biopsy specimen, suggesting a malignant lesion (H&E stain, ×100).

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