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Diagnosis by Endoscopy and Advanced Imaging of Barrett’s Neoplasia

  • Anne-Fré Swager
  • Wouter L. Curvers
  • Jacques J. BergmanEmail author
Chapter
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 908)

Abstract

Evaluation of patients with Barrett’s esophagus (BE) using dye-based chromoendoscopy, optical chromoendoscopy, autofluorescence imaging, or confocal laser endomicroscopy does not significantly increase the number of patients with a diagnosis of early neoplasia compared with high-definition white light endoscopy (HD-WLE) with random biopsy analysis. These newer imaging techniques are not more effective in standard surveillance of patients with BE because the prevalence of early neoplasia is low and HD-WLE with random biopsy analysis detects most cases of neoplasia. The evaluation and treatment of patients with BE and early stage neoplasia should be centralized in tertiary referral centers, where procedures are performed under optimal conditions, by expert endoscopists. Lesions that require resection are almost always detected by HD-WLE, although advanced imaging techniques can detect additional flat lesions. However, these are of limited clinical significance because they are effectively eradicated by ablation therapy. No endoscopic imaging technique can reliably assess submucosal or lymphangio invasion. Endoscopic resection of early stage neoplasia in patients with BE is important for staging and management. Optical chromoendoscopy can also be used to evaluate lesions before endoscopic resection and in follow-up after successful ablation therapy.

Keywords

Barrett’s esophagus Surveillance Detection of neoplasia Advanced imaging techniques Chromoendoscopy Autofluorescence imaging Confocal laser endomicroscopy Optical coherence tomography 

Abbreviations

AFI

Autofluorescence imaging

BE

Barrett’s esophagus

BLI

Blue laser imaging

CLE

Confocal laser endomicroscopy

EAC

Esophageal adenocarcinoma

ETMI

Endoscopic trimodal

FICE

Fujifilm intelligent chromo-endoscopy

HD

High-definition

HGD

High-grade dysplasia

IMC

Intramucosal carcinoma

LGD

Low-grade dysplasia

NBI

Narrow band imaging

OCT

Optical coherence tomography

OFDI

Optical frequency domain imaging

VLE

Volumetric laser endomicroscopy

WLE

White light endoscopy

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Anne-Fré Swager
    • 1
  • Wouter L. Curvers
    • 2
  • Jacques J. Bergman
    • 1
    Email author
  1. 1.Department of Gastroenterology and HepatologyAcademic Medical CenterAmsterdamThe Netherlands
  2. 2.Department of Gastroenterology and HepatologyCatharina HospitalEindhovenThe Netherlands

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