Is Malignant Potential of Barrett's Esophagus Predictable by Endoscopy Findings?

Abstract

Given that endoscopic findings can be used to predict the potential of neoplastic progression in Barrett's esophagus (BE) cases, the detection rate of dysplastic Barrett's lesions may become higher even in laborious endoscopic surveillance because a special attention is consequently paid. However, endoscopic findings for effective detection of the risk of neoplastic progression to esophageal adenocarcinoma (EAC) have not been confirmed, though some typical appearances are suggestive. In the present review, endoscopic findings that can be used predict malignant potential to EAC in BE cases are discussed. Conventional results obtained with white light endoscopy, such as length of BE, presence of esophagitis, ulceration, hiatal hernia, and nodularity, are used as indicators of a higher risk of neoplastic progression. However, there are controversies in some of those findings. Absence of palisade vessels may be also a new candidate predictor, as that reveals degree of intense inflammation and of cyclooxygenase-2 protein expression with accelerated cellular proliferation. Furthermore, an open type of mucosal pattern and enriched stromal blood vessels, which can be observed by image-enhanced endoscopy, including narrow band imaging, have been confirmed as factors useful for prediction of neoplastic progression of BE because they indicate more frequent cyclooxygenase-2 protein expression along with accelerated cellular proliferation. Should the malignant potential of BE be shown predictable by these endoscopic findings, that would simplify methods used for an effective surveillance, because patients requiring careful monitoring would be more easily identified. Development in the near future of a comprehensive scoring system for BE based on clinical factors, biomarkers and endoscopic predictors is required.

Keywords: Barrett’s esophagus; biomarkers; endoscopic predictor; endoscopic surveillance; esophageal adenocarcinoma.

Figure 1

Representative endoscopic findings of patients with segment Barrett’s esophagus (SSBE). Shown are cases with (a) visible and (b) invisible palisade vessels.

Figure 2

Crystal violet chromoendoscopic views of Barrett’ s esophagus with (a) close type and (b) open type mucosal pattern.

Figure 3

Micro-vascular pattern was divided into the following two categories: type I, uniform branched or vine-like pattern that is able to be traced smoothly (a), and type II, coiled or spiral pattern with a nonuniform shape that cannot be traced sufficiently and with increased vascularity (b).