Evaluation of patients with Barrett’s esophagus 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.
Dr Jacques Bergman and colleagues from the Netherlands examined the clinical consequences of advanced imaging techniques in Barrett's esophagus.
The team report that these newer imaging techniques are not more effective in standard surveillance of patients with Barrett’s esophagus because the prevalence of early neoplasia is low and HD-WLE with random biopsy analysis detects most cases of neoplasia.
|No endoscopic imaging technique can reliably assess submucosal or lymphangio-invasion|
|American Journal of Gastroenterology|
The evaluation and treatment of patients with Barrett’s esophagus and early-stage neoplasia should be centralized in tertiary referral centers, where procedures are performed under optimal conditions, by expert endoscopists.
The team note that 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.
The team observed that no endoscopic imaging technique can reliably assess submucosal or lymphangio-invasion.
Dr Jacques Bergman and colleagues comment, "Endoscopic resection of early-stage neoplasia in patients with Barrett’s esophagus 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."