DIAGNOSIS OF BARRETT’S ESOPHAGUS AND BARRETT’S ESOPHAGEAL CANCER BY ENDOSCOPY

Abstract

The number of cases of esophageal adenocarcinoma now exceeds those of squamous cell carcinoma in Western countries, and the annual number of cases of Barrett’s esophagus leading to esophageal cancer has increased more than 6 times over the past 25 years. We are also concerned with the increased incidence of Barrett’s adenocarcinoma in Japan. We believe that careful examination of the esophago-gastric junction is very important and necessary for accurate diagnosis of palisade vessels, upper end of the gastric folds, and consecutive columnar epithelium. Superficial cancer of short segment Barrett’s esophagus was often present in the direction of the anterior-right wall. It is primarily important not to miss redness or a rough surface on conventional white light endoscopy for detecting superficial Barrettʼs adenocarcinoma. White-light imaging, magnifying endoscopy with image-enhanced endoscopy （IEE）, endoscopic ultrasonography, and X-ray are useful for diagnosing the invasion depth. Flat 0−Ⅱb and 0−Ⅱa　lesions, 0-Ⅰlesions with a narrow base, and 0−Ⅱc lesions with a slight depression indicate mucosal cancer. IEE with magnifying endoscopy using acetic acid is useful for diagnosing the lateral extent of the lesions. Diagnosis of the invasion depth of superficial Barrett’s esophageal cancer is important for determination of the therapeutic strategy. Attention should be paid to the indications for endoscopic treatment of T1a-DMM and SM tumors.