Diagnosis by endoscopy and advanced imaging.
Evaluation of patients with Barrett's oesophagus (BO) 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 BO 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 BO 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 BO 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.
Dept. of Gastroenterology and Hepatology Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands. Electronic address: a.swager@amc.uva.nl.
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A
Swager
Dept. of Gastroenterology and Hepatology Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands. Electronic address: w.l.curvers@amc.uva.nl.
W L
WL
Curvers
Dept. of Gastroenterology and Hepatology Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands. Electronic address: j.j.bergman@amc.uva.nl.
J J
JJ
Bergman
D001471:Barrett Esophagus / Q000150:complications / Q000175:diagnosis*; D003952:Diagnostic Imaging / Q000379:methods*; D004938:Esophageal Neoplasms / Q000209:etiology / Q000517:prevention & control*; D004945:Esophagoscopy / Q000379:methods*; D006801:Humans
Advanced imaging techniques; Barrett's oesophagus; Early neoplasia; Surveillance