[Fluorescence diagnostics of premalignant and malignant changes in patients with Barrett's esophagus: doubts and...

Increasing incidence of esophageal adenocarcinoma that mostly arises from Barrett's esophagus (BE) has been observed. Therefore sensitive methods for early detection of dysplasias and adenocarcinomas in BE are more and more necessary. Fluorescence endoscopy is an alternative or complementary to standard four-quadrant biopsies technique. The basics of diagnostics application of tissue autofluorescence and exogenous dyes fluorescence such as protoporphyrin IX, induced by 5-aminolevulinic acid are summarized. There are two methods of fluorescence diagnostics of dysplasia in BE: point fluorescence spectroscopy and real-time fluorescence imaging. Fluorescence spectroscopy is sensitive and specific but can be targeted only toward lesions visible in white-light endoscopy. Fluorescence imaging allows to examine large areas for occult foci of dysplasia but selectivity is somewhat limited by the background fluorescence of Barrett's mucosa. Laser induced fluorescent endoscopy (LIFE) images of esophageal dysplasia are presented. Up-to date results of fluorescence spectroscopy and fluorescence imaging of BE are reviewed. These results indicate fluorescence diagnostics promising and clinically useful for detection of early adenocarcinoma and dysplasia in BE.