Barrett's esophagus (BE) is one of the most prominent diseases in Western countries because of its potential to progress to dysplasia or adenocarcinoma. Recently, the American College of Gastroenterology (ACG), American Gastroenterology Association (AGA), and European Society of Gastrointestinal Endoscopy (ESGE) developed clinical guidelines for the diagnosis and management of BE. All three guidelines commonly stressed the necessity of the endoscopic eradication of confirmed, nonnodular low grade dysplasia or high grade dysplasia, as well as the endoscopic elimination of the remaining BE after an endoscopic resection of visible mucosal abnormalities. An endoscopic resection is also considered for the optimal management of esophageal adenocarcinoma confined to the mucosa (T1a), and even in selective cases of submucosal invasion (T1b). As endoscopic therapy becomes the mainstay for the treatment of BE and its complications, the eligibility of pathologic or endoscopic experts and the BE expert center are being set and strengthened. This paper introduces the statements of the ACG, AGA and ESGE guidelines and compares the similarities and differences between them.
Adenocarcinoma ; Barrett Esophagus ; Diagnosis ; Endoscopy, Gastrointestinal ; Esophageal Neoplasms ; Gastroenterology ; Mucous Membrane

In predisposed individuals with long standing gastroesophageal reflux disease (GERD), esophageal squamous mucosa can transform into columnar mucosa with intestinal metaplasia, commonly called Barrett's esophagus (BE). Barrett's mucosa can develop dysplasia, which can be a precursor for esophageal adenocarcinoma (EAC). However, most EAC cases are identified when esophageal symptoms develop, without prior BE or GERD diagnoses. While several gastrointestinal societies have published BE screening guidelines, these vary, and many recommendations are not based on high quality evidence. These guidelines are concordant in recommending targeted screening of predisposed individuals (eg, long standing GERD symptoms with age > 50 years, male sex, Caucasian race, obesity, and family history of BE or EAC), and against population based screening, or screening of GERD patients without risk factors. Targeted endoscopic screening programs provide earlier diagnosis of high grade dysplasia and EAC, and offer potential for endoscopic therapy, which can improve prognosis and outcome. On the other hand, endoscopic screening of the general population, unselected GERD patients, patients with significant comorbidities or patients with limited life expectancy is not cost-effective. New screening modalities, some of which do not require endoscopy, have the potential to reduce costs and expand access to screening for BE.
Adenocarcinoma ; Barrett Esophagus ; Comorbidity ; Diagnosis ; Endoscopy ; European Continental Ancestry Group ; Gastroesophageal Reflux ; Hand ; Humans ; Life Expectancy ; Male ; Mass Screening ; Metaplasia ; Mucous Membrane ; Obesity ; Prognosis ; Risk Factors

Barrett's esophagus (BE) is one of the most prominent diseases in Western countries because of its potential to progress to dysplasia or adenocarcinoma. Recently, the American College of Gastroenterology (ACG), American Gastroenterology Association (AGA), and European Society of Gastrointestinal Endoscopy (ESGE) developed clinical guidelines for the diagnosis and management of BE. All three guidelines commonly stressed the necessity of the endoscopic eradication of confirmed, nonnodular low grade dysplasia or high grade dysplasia, as well as the endoscopic elimination of the remaining BE after an endoscopic resection of visible mucosal abnormalities. An endoscopic resection is also considered for the optimal management of esophageal adenocarcinoma confined to the mucosa (T1a), and even in selective cases of submucosal invasion (T1b). As endoscopic therapy becomes the mainstay for the treatment of BE and its complications, the eligibility of pathologic or endoscopic experts and the BE expert center are being set and strengthened. This paper introduces the statements of the ACG, AGA and ESGE guidelines and compares the similarities and differences between them.
Adenocarcinoma ; Barrett Esophagus ; Diagnosis ; Endoscopy, Gastrointestinal ; Esophageal Neoplasms ; Gastroenterology ; Mucous Membrane

Capsule endoscopy can be a diagnostic option for patients with esophageal diseases who cannot tolerate esophagogastroduodenoscopy.Functional modifications of the capsule allow for thorough examination of the esophagus. Esophageal capsule endoscopy has so farfailed to show sufficient performance to justify the replacement of traditional endoscopy for the diagnosis of esophageal diseasesbecause the esophagus has a short transit time and common pathologies appear near the esophagogastric junction. However,technological improvements are being introduced to overcome the limitations of capsule endoscopy, which is expected to become agood alternative to conventional endoscopy.
Barrett Esophagus ; Capsule Endoscopy* ; Diagnosis ; Endoscopy ; Esophageal and Gastric Varices ; Esophageal Diseases ; Esophagogastric Junction ; Esophagus ; Humans ; Pathology

BACKGROUND/AIMS: The higher prevalence of gastroesophageal reflux disease has preceded the increase of Barrett's esophagus and esophageal adenocarcinoma in Western countries. An increase of Barrett's esophagus and esophageal adenocarcinoma can also be predicted due to the increase of gastroesophageal reflux disease in Asia. Therefore, the ability of endoscopists to detect Barrett's esophagus can be important in the future. The aim of this study was to examine whether a short education program could improve the ability of gastrointestinal endoscopists and nurses to detect Barrett's esophagus. MATERIALS AND METHODS: Endoscopists and nurses of Gastrointestinal Endoscopic Center in Kosin Uinversity Gospel Hospital were enrolled in this study. Endoscopic images of biopsy proven Barrett's esophagus and normal gastroesophageal junction were obtained with conventional endoscopy. Thirty-seven still images of conventional endoscopy were used for slide test before and after 15 minutes education on Barrett's esophagus. RESULTS: Diagnostic ability of the doctor group after education did not changed (pre-education 79.6% vs. post-education 79.3%, P=0.906). Nurse group showed improved diagnostic ability for Barrett's esophagus after education (pre-education 68.7% vs. post-education 75.5%, P=0.008). After a short education program, inter-observer agreement of endoscopic diagnosis of Barrett's esophagus was improved in both doctor and nurse groups (doctor inter-observer correlation coefficient [ICC], 0.684→0.879; nurse ICC, 0.524→0.862). CONCLUSIONS: Even a short education program can improve the diagnostic ability, especially inter-observer agreement of endoscopic diagnosis for Barrett's esophagus. Further studies are needed to establish a role of education to improve diagnostic ability of Barrett's esophagus.
Adenocarcinoma ; Asia ; Barrett Esophagus* ; Biopsy ; Diagnosis ; Education* ; Endoscopy ; Esophagogastric Junction ; Gastroesophageal Reflux ; Prevalence

Confocal laser endomicroscopy (CLE) is a new technology enabling endoscopists to visualize tissue at the cellular level. CLE has the fundamental potential to provide a histologic diagnosis, and may theoretically replace or reduce the need for performing biopsy for histology. The clinical benefits of CLE are more obvious in esophageal disease, including Barrett's esophagus. Currently, this technology has been adapted to the diagnosis and surveillance of Barrett's esophagus and related neoplasia. Standard white light endoscopy is the primary tool for gastric cancer screening. Currently, the only method available to precisely diagnose these lesions is upper endoscopy with an appropriate biopsy. A recent study showed that CLE could characterize dysplasia or cancer and identify the risk factors for gastric cancer, such as intestinal metaplasia and the presence of Helicobacter pylori in vivo, although fewer studies on CLE were performed on the stomach than on Barrett's esophagus and other esophageal diseases. However, the application of CLE to routine clinical endoscopy continues to be refined. This review focused on the usefulness and future prospects of CLE for gastric premalignant and malignant lesions.
Barrett Esophagus ; Biopsy ; Diagnosis ; Endoscopy ; Esophageal Diseases ; Helicobacter pylori ; Mass Screening ; Metaplasia ; Risk Factors ; Stomach ; Stomach Neoplasms

PURPOSE: During sedated esophagogastroduodenoscopy (EGD), patients may not be able to perform inspiration, which is necessary to examine the esophagogastric junction. Therefore sedation may affect diagnosis of gastroesophageal reflux-related findings. The aim of our study was to investigate the effect of sedation on diagnosis of gastroesophageal reflux-related findings during EGD. MATERIALS AND METHODS: This retrospective study evaluated 28914 patients older than 20 years who underwent EGD at our institution between January 2011 and December 2011. Ultimately, 1546 patients indicated for EGD for health check-up and symptom evaluation were included. RESULTS: There were 18546 patients who had diagnostic EGD: 10471 patients (56%) by non-sedated EGD and 8075 patients (43%) by sedated EGD. After statistical adjustment for age, sex, and body mass index, minimal change esophagitis, and hiatal hernia were significantly less frequently observed in the sedated EGD group [odds ratio (OR), 0.651; 95% confidence interval (CI), 0.586 to 0.722 and OR, 0.699; 95% CI, 0.564 to 0.866]. Nevertheless, there was no significant difference in other findings at the gastroesophageal junction, such as reflux esophagitis with Los Angeles classification A, B, C, and D or Barrett's esophagus, between the two groups. Similarly, there were no differences in early gastric cancer, advanced gastric cancer, and gastric ulcer occurrence. CONCLUSION: Sedation can impede the detection of minimal change esophagitis and hiatal hernia, but does not influence detection of reflux esophagitis of definite severity and Barrett's esophagus.
Adult ; Aged ; Barrett Esophagus ; Body Mass Index ; Endoscopy, Digestive System/instrumentation/*methods ; Esophagitis, Peptic/*diagnosis ; Esophagogastric Junction/*pathology ; Female ; Gastroesophageal Reflux/*diagnosis ; Hernia, Hiatal/*diagnosis ; Humans ; Male ; Middle Aged ; Retrospective Studies

Detection of premalignant lesions in the upper gastrointestinal tract may facilitate endoscopic treatment and improve survival. Despite technological advances in white light endoscopy, its ability to detect premalignant lesions remains limited. Early detection could be improved by using advanced endoscopic imaging techniques, such as magnification endoscopy, narrow band imaging, i-scanning, flexible spectral imaging color enhancement, autofluorescence imaging, and confocal laser endomicroscopy (CLE), as these techniques may increase the rate of detection of mucosal abnormalities and allow optical diagnosis. The present review focuses on advanced endoscopic imaging techniques based on the use of CLE for diagnosing premalignant lesions in Barrett esophagus and stomach.
Barrett Esophagus* ; Diagnosis ; Endoscopy ; Molecular Imaging* ; Narrow Band Imaging ; Optical Imaging ; Stomach Neoplasms ; Stomach* ; Upper Gastrointestinal Tract

Barrett's esophagus is an acquired condition in which the stratified squamous epithelium is replaced by metaplastic, intestinal-type columnar epithelium. It develops as a result of chronic gastroesophageal reflux disease, and predisposes to the development of esophageal adenocarcinoma. This review is focused on histologic diagnosis and differential diagnosis of Barrett's esophagus.
Adenocarcinoma ; Barrett Esophagus* ; Diagnosis ; Diagnosis, Differential ; Epithelium ; Gastroesophageal Reflux

Barrett's esophagus (BE) is the only known precursor to esophageal adenocarcinoma (EAC), whose incidence has increased sharply in the last 4 decades. The annual conversion rate of BE to cancer is significant, but small. The identification of patients at a higher risk of cancer therefore poses a clinical conundrum. Currently, endoscopic surveillance is recommended in BE patients, with the aim of diagnosing either dysplasia or cancer at early stages, both of which are curable with minimally invasive endoscopic techniques. There is a large variation in clinical practice for endoscopic surveillance, and dysplasia as a marker of increased risk is affected by sampling error and high interobserver variability. Screening programs have not yet been formally accepted, mainly due to the economic burden that would be generated by upper gastrointestinal endoscopy. Screening programs have not yet been formally accepted, mainly due to the economic burden that would be generated by widespread indication to upper gastrointestinal endoscopy. In fact, it is currently difficult to formulate an accurate algorithm to confidently target the population at risk, based on the known clinical risk factors for BE and EAC. This review will focus on the clinical and molecular factors that are involved in the development of BE and its conversion to cancer and on how increased knowledge in these areas can improve the clinical management of the disease.
Adenocarcinoma/*etiology ; Animals ; Barrett Esophagus/*complications/diagnosis ; Diagnostic Imaging/methods ; Disease Models, Animal ; Epigenesis, Genetic/physiology ; Esophageal Neoplasms/diagnosis/*etiology ; Esophagoscopy/methods ; Forecasting ; Genetic Markers/physiology ; Humans ; Mice ; Practice Guidelines as Topic ; Risk Factors