| The incidence and prevalence of esophageal adenocarcinoma and Barrett’s esophagus (BE) has increased markedly in recent decades. Diagnosis of precursors lesions as dysplasia confers a challenge, since lesions can be patchy, occupying just a fraction of the total surface, hence, it may be macroscopically indistinguishable from the background non-dysplastic mucosa. BE should be diagnosed when there is extension of salmon colored mucosa into the tubular esophagus, extending ≥1 cm proximal to the EGJ with biopsy confirmation of IM. Image Enhanced Endoscopy (IEE) has demonstrated superiority over standard definition imaging to diagnose dysplasia with the need of fewer number of targeted biopsies. The Barrett’s International NBI group that classified mucosal and vascular pattern into regular and irregular patterns, accurately identified dysplasia with an 85% overall accuracy and an inter-observer agreement of 0.68. In patients with macroscopic LGD, HGD, or T1 cancer, endoscopic therapy is the preferred therapeutic approach followed by endoscopic ablative therapy of the remaining BE. Novel IEE technologies for diagnosis as BLI, and treatment modalities as EMR and ESD, are presented and discussed. In addition, a general overview of the WEO Rio Barrett’s Consensus on definitions, terminology and classification systems will be presented and discussed. |
