Magnifying endoscopy in the diagnosis of Barrett's esophagus and Barrett's adenocarcinoma

Magnifying endoscopy with dye or acetic acid is useful for evaluating mucosal surface patterns in patients with Barrett's epithelium. Barrett's epithelium can be diagnosed on the basis of the presence of translucent longitudinal vessels. Specialized intestinal metaplasia frequently occurs in villous- or gyrus-type mucosa. Superficial Barrett's adenocarcinoma is associated with irregularities or destruction of mucosal surface patterns. Magnifying endoscopy combined with optical chromoendoscopy by new techniques for enhancement of vascular images, such as narrow-band imaging (NBI) and Fuji intelligent color enhancement (FICE), may further improve diagnostic accuracy. Irregularly arranged abnormal vessels appear in cancerous lesions. However, classification systems for characteristic vascular patterns have not been established. Whether vascular patterns are useful for diagnosing cancers with mild atypia remains an open question.