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

• Published in: Clinical endoscopy Vol. 47; no. 1; pp. 47 - 54
• Main Authors: Alberto Espino, Maria Cirocco, Ralph Dacosta, Norman Marcon
• Format: Journal Article
• Language: Korean
• Published: 대한소화기내시경학회 30.01.2014
• Subjects: Advanced imaging; Barrett esophagus; Esophageal adenocarcinoma
• ISSN: 2234-2400

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 laborintensive 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 enhan 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.