Kurdistan Board GEH/GIT Surgery weekly J Club:Supervised by:

Professor Dr.Mohamed AlshekhaniMBChB-CABM,FRCP,EBGH.

Barrets esophagus:Barrets esophagus: A pre-malignant condition associated with EAC.A pre-malignant condition associated with EAC. Currently white light endoscopy & biopsy is the Currently white light endoscopy & biopsy is the

mainstay diagnostic tool , but troubled by issues mainstay diagnostic tool , but troubled by issues related to cumbersome biopsy sampling, biopsy related to cumbersome biopsy sampling, biopsy sampling errors & cost. sampling errors & cost.

Therefore in order to overcome such adversity, Therefore in order to overcome such adversity, there needs to be evolutionary advancement in there needs to be evolutionary advancement in terms of diagnosis, which should address these terms of diagnosis, which should address these concerns & ideally enhance risk stratification in concerns & ideally enhance risk stratification in order to provide timely management in real time. order to provide timely management in real time.

This review highlights the current endoscopic This review highlights the current endoscopic tools aimed to enhance the diagnosis of BE& its tools aimed to enhance the diagnosis of BE& its subsequent progression.subsequent progression.

Endo Classification of pit pattern of Barrett’s epithelium by magnifying endoscopy. Endoscopic views at right were obtained without methylene blue staining and those at left after application of methylene blue. Note that mucosa with pit-1, pit-2, and pit-3 patterns was not stained by the dye, whereas positive staining is evident within mucosa with pit-4 and pit-5 patterns Endo et al.

High−resolution white−light imaging (left) and indigo carmine chromoendoscopy (right) of a small mucosal lesion (type IIb) at the 6−o’clock position (arrows), detected in a patient with Barrett’s esophagus. This area was regarded as suspicious after spraying of indigo carmine. High grade dysplasia was found in the corresponding biopsy specimens

Acetic acid:Acetic acid:

Optical Coherence Tomography images showing normal cardia and a cross sectional image through the squamous oesophagus

The risk of oesophageal The risk of oesophageal adenocarcinomaadenocarcinoma

in a prospectively recruited in a prospectively recruited Barrett’sBarrett’s

Progression to OAC appeared stable over three Progression to OAC appeared stable over three decades at 0.47% per annum. decades at 0.47% per annum.

Patients with BO had a modest increase in all-Patients with BO had a modest increase in all-cause mortality & a large increase in OAC cause mortality & a large increase in OAC mortality, particularly if fit for surveillance.mortality, particularly if fit for surveillance.

Low-grade dysplasia&the length of the BO Low-grade dysplasia&the length of the BO segment were associated with developing OAC.segment were associated with developing OAC.

ueg.sagepub.com on December 3, 2016ueg.sagepub.com on December 3, 2016

Abstract:Abstract: Aim to detect early lesions amenable to curative endoscopic Aim to detect early lesions amenable to curative endoscopic

trt.trt. This requires an improvement in diagnostics, with a focus on This requires an improvement in diagnostics, with a focus on

identifying & characterising subtle mucosal changes. identifying & characterising subtle mucosal changes. Optical technologies used to predict histology& enable the Optical technologies used to predict histology& enable the

formulation of a real-time in vivo diagnosis ‘optical biopsy’. formulation of a real-time in vivo diagnosis ‘optical biopsy’. In selected situations advanced imaging techniques are In selected situations advanced imaging techniques are

useful for optical diagnosis of GI pathology. useful for optical diagnosis of GI pathology. To date most used in clinical trials or within tertiary To date most used in clinical trials or within tertiary

hospitals with selected populations.hospitals with selected populations. These techniques however, represent progress in terms of These techniques however, represent progress in terms of

diagnostic capability &paradigm shift in the role of diagnostic capability &paradigm shift in the role of endoscopy in patient management. endoscopy in patient management.

Optical imaging is undoubtedly a useful addition in the Optical imaging is undoubtedly a useful addition in the armamentarium for the diagnosis of treatable early GIT armamentarium for the diagnosis of treatable early GIT pathology.pathology.