| Theme |
Diagnosis and Treatment of Barrett's Esophagus : up-to-date |
| Title |
Problems in Screening of Barrett's Esophagus |
| Author |
Toshiyuki Kubo |
Department of Endoscopy, Saku Central Hospital Advanced Care Center |
| Author |
Tsuneo Oyama |
Department of Endoscopy, Saku Central Hospital Advanced Care Center |
| Author |
Akiko Takahashi |
Department of Endoscopy, Saku Central Hospital Advanced Care Center |
| Author |
Tatsuo Morinushi |
Department of Endoscopy, Saku Central Hospital Advanced Care Center |
| [ Summary ] |
The majority of esophageal cancer is categorized as SCC (squamous cell carcinoma). EAC (esophageal adenocarcinoma) is rare. However, EAC has rapidly increased in western countries and came to occupy the major form of this type of cancer in 1998. On the other hand, the most common form of esophageal cancer is still SCC in Japan. However, EAC has increased from 1.4 % to 4.9 % of diagnosed cases, as judged by analysis of the national registration database of the Japanese Esophagus Society. A majority of Japanese EAC cases originate as SSBE. Therefore, they are often located near the EGJ (esophagogastric junction). Sometimes EGJ is difficult to observe because of narrow lumina. Therefore, deep inspiration should be used for observation.
Endoscopic findings of EAC are basically similar to those for early gastric cancer. We must pay close attention to detect color changes, elevations and depressions. The standard strategy for surveillance of EAC in the USA is random biopsies. Quadrant biopsies every 1-2 cm are recommended per the Seattle protocol, because endoscopic findings of superficial EAC are subtle. However, Japanese endoscopists have sufficient skills to detect superficial gastric cancer. Therefore, we attempt to detect EAC through endoscopic observation without random biopsies. If we observe lesions, further diagnosis should be conducted using chromoendoscopy, and IEE (Image-Enhanced Endoscopy). |