Advanced Imaging for Barrett’s Esophagus and Early Neoplasia: Surface and Subsurface Imaging for Diagnosis and Management

  • Mansoureh Mkarimi
  • Hiroshi MashimoEmail author
Esophagus (J Clarke and N Ahuja, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Esophagus


Purpose of Review

Esophageal adenocarcinoma bears one of the fastest rising incidence of any cancers and generally arises in the setting of gastroesophageal reflux and Barrett’s esophagus. However, early detection of neoplasia can be challenging since most patients are asymptomatic until they progress to more advanced and less curable stages, and early dysplastic lesions can be small, multifocal, and difficult to detect. Clearly, new imaging tools are needed in light of sampling error associated with random biopsies, the current standard of practice.

Recent Findings

Advances in endoscopic imaging including virtual chromoendoscopy, confocal laser endomicroscopy, and subsurface imaging with optical coherence tomography have ushered in a new era for detecting subtle neoplastic lesions. Moreover, in light of esophagus-sparing treatments for neoplastic lesions, such tools are likely to guide ablation and follow-up management.


While there is no ideal single imaging modality to facilitate improved detection, staging, ablation, and follow-up of patients with dysplastic Barrett’s esophagus, new advances in available technology, the potential for multimodal imaging, and the use of computer-aided diagnosis and biomarkers all hold great promise for improving detection and treatment.


Endoscopic imaging Chromoendoscopy Confocal laser endomicroscopy Optical coherence tomography Barrett’s esophagus Esophageal adenocarcinoma 



autofluorescence imaging


argon plasma coagulation


angle-resolved low-coherence interferometry


Barrett’s esophagus


Barrett’s International NBI Group


blue laser imaging


computer-aided diagnosis




confocal laser endomicroscopy


computed tomography


endoscopic CLE


esophageal adenocarcinoma


endoscopic mucosal resection


endoscopic polarized scanning spectroscopy


endoscopic submucosal dissection


elastic-scattering spectroscopy


endoscopic trimodal imaging


endoscopic ultrasound


flexible spectral imaging color enhancement


fluorescence laminar optical tomography


fine needle aspiration


gastroesophageal reflux disease


high-grade dysplasia


low-grade dysplasia


light-scattering spectroscopy


methylene blue


microelectromechanical systems


narrow-band imaging


negative predictive value


optical coherence tomography


optical coherence tomography and angiography


optical coherence tomography tethered capsule


optical coherence tomography scoring index


photoacoustic tomography


probe-based confocal laser endoscopy


positron emission tomography


Preservation and Incorporation of Valuable Endoscopic Innovation


positive predictive value


polarization-sensitive optical coherence tomography


radiofrequency ablation


volumetric laser endomicroscopy


targeted biopsies


volumetric laser endomicroscopy


volumetric laser endomicroscopy diagnostic algorithm


wide-area transepithelial sampling


white light endoscopy


Compliance with Ethical Standards

Conflict of Interest

Mansoureh Mkarimi declares no conflict of interest. Hiroshi Mashimo reports grants from Ninepoint Medical, outside the submitted work, and has a patent pending (No. 61/987,80 for a novel catheter design, “Scanning Optical Probe,” that is being used with the OCT technology in this study which is ongoing).

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2018

Authors and Affiliations

  1. 1.VA Boston HealthcareHarvard Medical SchoolWest RoxburyUSA

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