Novel Endoscopic Techniques for the Detection of Barrett's Dysplasia

Abstract

Barrett's esophagus is highly prevalent in the US population and is the only known precursor of esophageal adenocarcinoma, one of the most lethal and increasingly common cancers in the developed world. Over the past 4 decades, the incidence of esophageal adenocarcinoma has increased some 300% to 500%. This dramatic trend has sparked tremendous interest in the early diagnosis of Barrett's dysplasia. The diagnosis of dysplasia and early cancer in Barrett's esophagus presents a number of challenges. The current standard of random, four-quadrant biopsies has several limitations including sampling error and inconsistent histopathologic interpretation. Emerging technologies in the field of endoscopic microscopy and spectroscopy offer the potential for visual biopsies-real-time, in-situ diagnoses that can be rendered without removing tissue. Used as an adjunct to standard white-light endoscopy, these technologies may enhance the detection of dysplasia and early cancer, thus offering the potential for early diagnosis and improved survival. This article reviews the current status of these novel, optical-based diagnostic technologies and their emerging role in the endoscopic detection of esophageal neoplasia.

Figure 1

Narrow band imaging of a segment of Barrett’s esophagus. A central area with a distorted mucosal pattern and abnormal vascular pattern is seen (arrow).

Figure 2

Pathology from targeted biopsies of the area shown in Figure 1 confirmed the presence of high-grade dysplasia.

Figure 3

Confocal endoscopic image of Barrett’s mucosa (left) and corresponding histopathologic image. Photos courtesy of the Pentax Corporation.