Recent Updates in the Endoscopic Diagnosis of Barrett's Oesophagus

Barrett's oesophagus (BO) is a premalignant condition associated with the development of oesophageal adenocarcinoma (OAC). Despite the low risk of progression per annum, OAC is associated with significant morbidity and mortality, with an estimated 5-year survival of 10%. Furthermore, the incidence of OAC continues to rise globally. Therefore, it is imperative to detect the premalignant phase of BO and follow up such patients accordingly.

The mainstay diagnosis of BO is endoscopy and biopsy sampling. However, limitations with white light endoscopy (WLE) and undertaking biopsies have shifted the current focus towards real-time image analysis. Utilization of additional tools such as chromoendoscopy, narrow-band imaging (NBI), confocal laser endomicroscopy (CLE), and optical coherence tomography (OCT) are proving beneficial. Furthermore, it is also becoming more apparent that often these tools are utilized by experts in the field. Therefore, for the non-expert, training in these systems is key. Currently as yet, the methodologies used for training optimization require further inquiry.

(1) Real-time imaging can serve to minimize excess biopsies. (2) Tools such as chromoendoscopy, NBI, CLE, and OCT can help to compliment WLE.

WLE is associated with limited sensitivity. Biopsy sampling is cost-ineffective and associated with sampling error. Hence, from a practical perspective, endoscopists should aim to utilize additional tools to help in real-time image interpretation and minimize an overreliance on histology.