Barrett’s esophagus: current standards in advanced imaging

Abstract

Rationale for Barrett's esophagus (BE) screening and surveillance endoscopyBE is the only identifiable precursor lesion of EAC and affects up to 5% of the general population (6). It results from chronic acid exposure of the stratified squamous epithelium in the distal esophagus leading to metaplasia and replacement with intestinal type columnar epithelium. BE is believed to progress from non-dysplastic (NDBE) → low

The Role of Artificial Intelligence in Surveillance in Barrett’s Esophagus and Gastric Intestinal Metaplasia

“…The current standard of care in most community gastroenterology practices is white light high-resolution endoscopy with sampling of the Barrett's segment every 2 cm from all 4 quadrants, known as the Seattle protocol, which has been shown in studies to sample less than 5% of the mucosal surface. 14 Additionally, biopsies are taken from lesions that appear suspicious, such as raised or depressed lesions, nodular areas, and foci of ulceration. Random as well as targeted biopsies have the inherent disadvantage of sampling errors, inability to identify sub-squamous changes and there can be subtle changes in mucosal patterns imperceptible to the human eye due to improper and inadequate examination.…”

How I Do It: Surveillance Endoscopy for Barrett’s Esophagus and Gastric Intestinal Metaplasia

“…The principles of a high quality exam apply to any BE evaluation and I follow the 10 step approach 7 as endorsed by ACG guidelines. 4 Use of a clear distal attachment cap facilitates visualization and provides a stable position to get close to the mucosa.…”

Incorporating image enhanced endoscopy in your everyday practice

“…Virtual chromoendoscopy can be switched on and off simply using a button at the endoscope. Available systems are called NBI (narrow band imaging, Olympus), FICE (Fujinon) or i-Scan (Pentax) [7].…”