Barrett's Esophagus Clinical Trial
Official title:
Imaging Enhanced Endoscopy for the Screening of Barrett's Esophagus and Evaluation of Its Invasiveness in Patients With Gastroesophageal Reflux Disease
Imaging enhanced endoscopy can improve the efficacy of screening of Barrett's esophagus and
predict its invasiveness. There is potentially molecular change over the Barrett's esophagus
in this Chinese population.
To evaluate the efficacy of imaging enhanced endoscopy for screening of Barrett's esophagus
and evaluation of invasiveness
Barrett ' s esophagus, defined as a pathological finding of metaplastic change of esophageal
mucosa from squamous to columnar epithelium, is a tongue-like extension of salmon-colored
mucosa from the gastroesophageal junction by endoscopy (1 2,3) . Endoscopic abnormalities
suggestive of BE which has not been confirmed by histology, are defined as endoscopically
suspected esophageal metaplasia (ESEM) (2). Barrett's esophagus is considered a precancerous
lesion of esophageal adenocarcinoma (4 5) and it's mandatory for accurate diagnosis of BE.
The pathogenesis of BE has also been closely associated with gastroesophageal reflux disease
(6). In Western countries the reported prevalence of BE has varied from 0.9 to 4.5 % (3,7,8)
in the general population and 6.3 to 13.6 % (9 - 12) in patients with GERD. For reliably
rating differences of severity of endoscopically identified lesions among studies or
quantify progression or regression of BE, International Working Group for the Classification
of Oesophagitis (IWGCOA) proposed new classification of BE, the Prague C and M criteria (13)
for defining the extent of BE based on the circumference (C) and maximum (M) of the lesion.
This standard grading system could allow comparison of the severity of BE and aid in
following the natural course of BE Image-enhanced endoscopy (IEE) compromises various means
of enhancing contrast during endoscopy using dye, optical, and/or electronic methods IEE
allows improved visualization of lesions and can be used to gain insight into the pathology
of the lesion, Recent progress in optics and computerized processing of endoscopic images,
such as narrow band image (NBI) and Fuji intelligent Chromoendoscopy (FICE), provide an
optical and/or electronic enhancement of the mucosal structures. Most recently, the
EPKi-processor (Pentax, Tokyo, Japan) developed i-Scan, a novel endoscopic post-processing
light filter technology using delicate software algorithms with real-time image mapping
technology, which can provide detailed analysis based on vessel (i-Scan V), pattern (i-Scan
P), or surface architecture (i-Scan SE). Resolution of about 1.25 mega pixels per image
could be provided by the computer-controlled digital processing. The SE-mode could be used
for the identification of the morphological changes of esophageal mucosa. Accordingly,
i-Scan e- and b-modes could be used to further evaluate the lesions, such as the regularity
of vascular pattern and the presence of the abnormal vessels.
According to previous study (14), Ki67 and p53 immuno-histochemistry could reduce
interobserver variation in assessment of Barrett's oesophagus. These IHC methods correlate
with the severity of dysplasia very well and are useful supplementary prognostic markers In
our study, we use the image enhanced endoscopy to observe the endoscopically suspected
esophageal metaplasia and record it with Prague C and M criteria grading system.
Immuno-histochemical staining was used as supplementary prognostic markers. Our aim is to
evaluate the efficacy of imaging enhanced endoscopy for screening of Barrett's esophagus and
evaluation of invasiveness.
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Observational Model: Cohort, Time Perspective: Prospective
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