The usefulness of white light endoscopy, narrow band imaging, and magnification for the optimization of diagnosis in Barrett’s esophagus

Abstract

The diagnosis of dysplasia and early neoplasia in Barrett's esophagus by conventional endoscopy is based on a four-quadrant random biopsies protocol that is prone to sampling errors. Novel endoscopic techniques have been developed to enhance the detection of premalignant and malignant lesions by real time assessment of microvasculare architecture and mucosal structure. Chromoendoscopy with magnification has improved the visualization of lesions, but the dye application impairs a clear evaluation of vascular network. Narrow band imaging endoscopy enhances vascular imaging by using narrow bandwidth lights, with penetration to superficial mucosal structures. Different classification systems of mucosal and vascular patterns have been developed to improve the diagnostic accuracy of non-dysplastic and dysplastic BE, as well as of early esophageal cancer. This article is focused on both the clinical benefits and controversies surrounding conventional and advanced endoscopic methods used for screening and surveillance of patients with Barrett's esophagus. Current evidence shows that the adoption of new technology in routine practice requires a high level of performance as well as the standardization of various classification systems.

Barrett’s Esophagus in Romania: what do we know?

“…Prevalence of BE in general population undergoing upper digestive endoscopy for various complaints is 1% in European studies (Italian 1.3% and Swedish 1.6%) and 5.6% in the United States [28] vs. 2.2% in Romania (Saraci G et al [5]).…”

“…In all Romanian articles describing WLE, biopsies were taken according to Seattle protocol [28]. 116 Classification systems of esophageal dysplasia, as American Society for Gastrointestinal Endoscopy classification and British Society of Gastroenterology revised Vienna classification and dysplasia subtypes are not mentioned in Romanian studies [29].…”