ENDOSCOPIC DIAGNOSIS OF BARRETT’S ESOPHAGEAL ADENOCARCINOMA

Abstract

The incidence of Barrett’s esophageal adenocarcinoma (EAC) has been increasing throughout the world, especially in Western countries. The characteristic endoscopic findings of superficial EAC are either elevation or depression, and color change. However, it is difficult to make a differential diagnosis of EAC from intestinal metastasis, inflammation and erosion by white light imaging (WLI). Therefore, random biopsies are recommended for the surveillance of EAC in Western countries.

According to the published data of the authors, almost half of EAC cases had 0-Ⅱb spreading, and making the diagnosis of 0-Ⅱb spreading by WLI is difficult. Observation of the surface and vascular pattern by magnifying endoscopy with narrow-band imaging (NBIME) is useful for the diagnosis of lateral extension. Ninety-four percent of cases of 0-Ⅱb spreading were diagnosed correctly by NBIME.

However, it is more difficult to make the diagnosis of superficial EAC in patients with long segment (LS) Barrett’s esophagus (BE) than in patients with short segment BE. Therefore, the surveillance in LSBE patients should be performed by experienced endoscopists. A surveillance system that does not use random biopsy should be established using NBIME.