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.

Correction of cardioesophageal transition as a stage of treatment after endoscopic welding of esophageal metaplasia

“…Це узгоджується з іншими дослідженнями, в яких повідомлялося про 11,8% пацієнтів, яким необхідно було виконувати операцію [2,20]. Прогресування раку стравоходу залишається важливою проблемою у цих пацієнтів [1,15]. Хоча загальний успіх ендоскопічних методів був високим, більшість все ще ризикували захворіти цим важким для лікування захворюванням.…”

Endoscopic diagnosis and screening of Barrett's esophagus: Inconsistency of diagnostic criteria between Japan and Western countries

“…Because the increasing length of the BE segment is a known risk factor for the development of EAC, most recent guidelines recommend recording the length of BE in centimeters using these criteria. 10 , 57 , 58 , 59 …”

“… 36,56 This system classifies BE based on both the length of circumferential involvement and the maximal proximal extent of endoscopically visible columnar mucosa in the esophagus to simplify and standardize endoscopic characterization of the length and shape of BE. Because the increasing length of the BE segment is a known risk factor for the development of EAC, most recent guidelines recommend recording the length of BE in centimeters using these criteria 10,57–59 …”

“… 5 , 6 , 7 Barrett's esophagus (BE) is the only known premalignant condition for EAC, characterized by the replacement of normal stratified squamous epithelium with columnar metaplasia in response to chronic gastroesophageal reflux. 8 , 9 , 10 …”

“…Although the incidence of ESCC remains high, accounting for approximately 90% of all esophageal cancer cases in Japan, the incidence of EAC was reported to have increased steadily, more than threefold, for the past two decades according to the comprehensive registry of esophageal cancer in Japan 5–7 . Barrett's esophagus (BE) is the only known premalignant condition for EAC, characterized by the replacement of normal stratified squamous epithelium with columnar metaplasia in response to chronic gastroesophageal reflux 8–10 …”