This document reviews endoscopic tools for diagnosing Barrett's esophagus (BE) and its progression. It discusses current diagnostic methods like white light endoscopy and biopsy, which have issues like sampling errors and costs. Newer optical technologies aim to improve diagnosis by identifying subtle mucosal changes to predict histology and enable real-time "optical biopsy". Several imaging techniques are presented that can diagnose GI pathology in selected situations, though most are only used in clinical trials or specialized hospitals currently. Optical imaging represents progress in diagnostic capabilities and a shift to endoscopy directly guiding patient management.

1. Kurdistan Board GEH/GIT Surgery weekly J
Club:
Supervised by:
Professor Dr.Mohamed Alshekhani
MBChB-CABM,FRCP,EBGH.

2. 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 mainstayCurrently white light endoscopy & biopsy is the mainstay
diagnostic tool , but troubled by issues related to cumbersomediagnostic tool , but troubled by issues related to cumbersome
biopsy sampling, biopsy sampling errors & cost.biopsy sampling, biopsy sampling errors & cost.
 Therefore in order to overcome such adversity, there needs to beTherefore in order to overcome such adversity, there needs to be
evolutionary advancement in terms of diagnosis, which shouldevolutionary advancement in terms of diagnosis, which should
address these concerns & ideally enhance risk stratification inaddress these 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 tools aimed toThis review highlights the current endoscopic tools aimed to
enhance the diagnosis of BE& its subsequent progression.enhance the diagnosis of BE& its subsequent progression.

7. 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.

8. 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

9. Acetic acid:Acetic acid:

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

15. The risk of oesophageal adenocarcinomaThe risk of oesophageal adenocarcinoma
in a prospectively recruited Barrett’sin a prospectively recruited Barrett’s
 Progression to OAC appeared stable over three decades at 0.47%Progression to OAC appeared stable over three decades at 0.47%
per annum.per annum.
 Patients with BO had a modest increase in all-cause mortality & aPatients with BO had a modest increase in all-cause mortality & a
large increase in OAC mortality, particularly if fit for surveillance.large increase in OAC mortality, particularly if fit for surveillance.
 Low-grade dysplasia&the length of the BO segment wereLow-grade dysplasia&the length of the BO segment were
associated with developing OAC.associated with developing OAC.
 ueg.sagepub.com on December 3, 2016ueg.sagepub.com on December 3, 2016

21. Abstract:Abstract:
 Aim to detect early lesions amenable to curative endoscopic trt.Aim to detect early lesions amenable to curative endoscopic trt.
 This requires an improvement in diagnostics, with a focus onThis 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 theOptical 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 useful forIn selected situations advanced imaging techniques are useful for
optical diagnosis of GI pathology.optical diagnosis of GI pathology.
 To date most used in clinical trials or within tertiary hospitals withTo date most used in clinical trials or within tertiary hospitals with
selected populations.selected populations.
 These techniques however, represent progress in terms ofThese techniques however, represent progress in terms of
diagnostic capability &paradigm shift in the role of endoscopy indiagnostic capability &paradigm shift in the role of endoscopy in
patient management.patient management.
 Optical imaging is undoubtedly a useful addition in theOptical imaging is undoubtedly a useful addition in the
armamentarium for the diagnosis of treatable early GIT pathology.armamentarium for the diagnosis of treatable early GIT pathology.