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World J Gastroenterol. Oct 7, 2010; 16(37): 4640-4645
Published online Oct 7, 2010. doi: 10.3748/wjg.v16.i37.4640
Era of Barrett’s surveillance: Does equipment matter?
Jayan Mannath, Krish Ragunath
Jayan Mannath, Krish Ragunath, Nottingham Digestive Diseases Centre and NIHR Biomedical Research Unit, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, United Kingdom
Author contributions: Mannath J performed the literature search and prepared the manuscript; Ragunath K reviewed the evidence and modified the manuscript.
Correspondence to: Dr. Krish Ragunath, MD, MPhil, FRCP, Associate Professor and Reader in Endoscopy, Nottingham Digestive Diseases Centre and NIHR Biomedical Research Unit, Queen’s Medical Centre Campus, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, United Kingdom. k.ragunath@nottingham.ac.uk
Telephone: +44-115-8231035 Fax: +44-115-8231090
Received: February 24, 2010
Revised: April 4, 2010
Accepted: April 11, 2010
Published online: October 7, 2010
Abstract

Barrett’s esophagus is a consequence of long standing gastro-esophageal reflux disease and predisposes to the development of esophageal adenocarcinoma. Regular surveillance endoscopies can detect curable early neoplasia in asymptomatic patients, which in turn could improve the prognosis compared to symptomatic cancer. Early neoplastic lesions, which are amenable for local therapy, could be treated endoscopically, avoiding a major surgery. However, in the absence of obvious mucosal lesions, random four quadrant biopsies are done, which is associated with significant sampling error. Newer imaging modalities, such as autofluorescence endoscopy, are helpful in detecting subtle lesions that could be examined in detail with narrow band imaging to characterize and target biopsies. This has the potential benefit of reducing the number of random biopsies with a better yield of dysplasia. Confocal endomicroscopy provides “optical biopsies” and is a valuable tool in targeting biopsies to improve dysplasia detection; however, this is technically challenging. Fuji intelligent chromoendoscopy and I-Scan are recent additions to the imaging armamentarium that have produced notable early results. While all these additional new imaging techniques are promising, a thorough examination by high resolution white light endoscopy after clearing the mucosa with mucolytics should be the minimum standard to improve dysplasia detection during Barrett’s surveillance.

Keywords: Barrett’s esophagus; Endoscopy; Autofluorescence imaging; Narrowband imaging; Early diagnosis of cancer