Imaging for Barrett's esophagus: state of the art

Barrett's esophagus is the premalignant condition for esophageal cancer and the diagnosis of esophageal adenocarcinoma on index endoscopy is increasing. Many advanced endoscopic techniques are available and aim to identify Barrett's esophagus-associated neoplasia earlier, thereby preventing progression into malignancy.

It is well established adherence to Seattle protocol increases dysplasia detection but leaves large portions of mucosa unsampled. Recent attention has been given to wide-area transepithelial sampling as an additional means of biopsy and shows increased dysplasia detection rates. Many endoscopic techniques aim to increase the success of diagnosis of Barrett's esophagus-associated neoplasia, including probe confocal endomicroscopy, volumetric laser endomicroscopy, and virtual chromoendoscopy. Interestingly, volumetric laser endomicroscopy may also be useful in delineating margins during endoscopic mucosal resection, leading to both diagnostic and therapeutic applications.

Advanced endoscopic techniques are available to increase detection of Barrett's esophagus-associated neoplasia; however, these remain localized to academic centers of excellence. With recent advancements in both sampling techniques and the potential application of imaging to therapeutics, these techniques are becoming more accessible to community endoscopists.