Barrett's esophagus: current standards in advanced imaging

Abstract

Esophageal adenocarcinoma (EAC) continues to be one of the fastest rising incident cancers in the Western population with the majority of patients presenting with late stage disease and associated with a dismal 5-year survival rate. Barrett's esophagus (BE) is the only identifiable precursor lesion to EAC. Strategies to screen for and survey BE are critical to detect earlier cancers and reduce morbidity and mortality related to EAC. A high-quality endoscopic examination with careful inspection of the Barrett's segment and adherence to the Seattle protocol for tissue sampling are critical. Advanced imaging modalities offer the potential to improve dysplasia detection, predict histopathology in real time and guide endoscopic eradication therapy (EET). Several technologies have been studied and although most are not yet recommended for routine clinical practice, high definition white light endoscopy (HD-WLE) as well as chromoendoscopy (including virtual chromoendoscopy) improved dysplasia detection in numerous studies supporting their use. Future studies should evaluate the role of artificial intelligence in optimizing detection of dysplasia in BE patients.

Keywords: Barrett’s esophagus (BE); Esophageal adenocarcinoma (EAC); advanced imaging; chromoendoscopy.

Figure 1

Description of visible lesions in Barrett’s Esophagus using the Paris Classification. (A) Nodule (Paris 0-IIa) in an area of previous ablation; (B) nodular area (Paris 0-IIa) with abnormal mucosal and vascular pattern under NBI. NBI, narrow band imaging.

Figure 2

Use of advanced imaging to guide endoscopic eradication therapy. (A) high definition white light endoscopy of Barrett’s Segment; (B) subtle area of nodularity (Paris 0-II) extending from the 9 to 3 o’clock position; (C) closer inspection of mucosal and vascular pattern using NBI and near focus; (D) marking prior to endoscopic mucosal resection; (E) status post endoscopic mucosal resection.