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Diagnosis by Endoscopy and Advanced Imaging of Barrett’s Neoplasia

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Stem Cells, Pre-neoplasia, and Early Cancer of the Upper Gastrointestinal Tract

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 908))

Abstract

Evaluation of patients with Barrett’s esophagus (BE) using dye-based chromoendoscopy, optical chromoendoscopy, autofluorescence imaging, or confocal laser endomicroscopy does not significantly increase the number of patients with a diagnosis of early neoplasia compared with high-definition white light endoscopy (HD-WLE) with random biopsy analysis. These newer imaging techniques are not more effective in standard surveillance of patients with BE because the prevalence of early neoplasia is low and HD-WLE with random biopsy analysis detects most cases of neoplasia. The evaluation and treatment of patients with BE and early stage neoplasia should be centralized in tertiary referral centers, where procedures are performed under optimal conditions, by expert endoscopists. Lesions that require resection are almost always detected by HD-WLE, although advanced imaging techniques can detect additional flat lesions. However, these are of limited clinical significance because they are effectively eradicated by ablation therapy. No endoscopic imaging technique can reliably assess submucosal or lymphangio invasion. Endoscopic resection of early stage neoplasia in patients with BE is important for staging and management. Optical chromoendoscopy can also be used to evaluate lesions before endoscopic resection and in follow-up after successful ablation therapy.

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Abbreviations

AFI:

Autofluorescence imaging

BE:

Barrett’s esophagus

BLI:

Blue laser imaging

CLE:

Confocal laser endomicroscopy

EAC:

Esophageal adenocarcinoma

ETMI:

Endoscopic trimodal

FICE:

Fujifilm intelligent chromo-endoscopy

HD:

High-definition

HGD:

High-grade dysplasia

IMC:

Intramucosal carcinoma

LGD:

Low-grade dysplasia

NBI:

Narrow band imaging

OCT:

Optical coherence tomography

OFDI:

Optical frequency domain imaging

VLE:

Volumetric laser endomicroscopy

WLE:

White light endoscopy

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Academic Medical Center, Room B1-245, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands

    Anne-Fré Swager M.D. & Jacques J. Bergman M.D., Ph.D.

  2. Department of Gastroenterology and Hepatology, Catharina Hospital, Michelangelolaan 2, Eindhoven, 5623 EJ, The Netherlands

    Wouter L. Curvers M.D., Ph.D.

Authors
  1. Anne-Fré Swager M.D.
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  2. Wouter L. Curvers M.D., Ph.D.
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  3. Jacques J. Bergman M.D., Ph.D.
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Correspondence to Jacques J. Bergman M.D., Ph.D. .

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Editors and Affiliations

  1. UCL Cancer Institute, University College London, London, United Kingdom

    Marnix Jansen

  2. Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom

    Nicholas A. Wright

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Swager, AF., Curvers, W.L., Bergman, J.J. (2016). Diagnosis by Endoscopy and Advanced Imaging of Barrett’s Neoplasia. In: Jansen, M., Wright, N. (eds) Stem Cells, Pre-neoplasia, and Early Cancer of the Upper Gastrointestinal Tract. Advances in Experimental Medicine and Biology, vol 908. Springer, Cham. https://doi.org/10.1007/978-3-319-41388-4_5

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