van Heijst Lisanne E, Zhao Xiaojuan, Gabriëls Ruben Y, Nagengast Wouter B
Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Gastroenterology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China.
Visc Med. 2022 Jun;38(3):182-188. doi: 10.1159/000523907. Epub 2022 Mar 30.
Esophageal adenocarcinoma (EAC) is one of the main causes of cancer-related deaths worldwide and its incidence is rising. Barrett's esophagus (BE) can develop low- and high-grade dysplasia which can progress to EAC overtime. The golden standard to detect dysplastic BE (DBE) or EAC is surveillance with high-definition white-light endoscopy (HD-WLE) and random biopsies according to the Seattle protocol. However, this method is time-consuming and associated with a remarkable miss rate. Therefore, there is great need for the development of novel reliable techniques to optimize surveillance strategies and improve detection rates.
Optical chromoendoscopy (OC) techniques like narrow-band imaging have shown improved detection of DBE and EAC compared to HD-WLE and random biopsies. Most recent OC techniques, including the iSCAN optical enhancement system and linked color imaging, showed improved characterization of DBE and EAC retrospectively. Fluorescence molecular endoscopy (FME) presented promising results to highlight DBE and EAC. Moreover, with the establishment of well-performing delineation computer-aided detection (CAD) algorithms and the first real-time CAD system for EAC, we expect clinical application of CAD in the near future.
Despite impressive progress made in the development of advanced endoscopic techniques, combined HD-WLE/OC followed by random biopsies remains the golden standard for BE surveillance. Surveillance depends on appropriate mucosal cleansing, sufficient inspection time, and competence of the performing gastroenterologist to improve detection of EAC. In addition, to facilitate the clinical implementation of advanced endoscopic techniques, multicenter prospective clinical studies are demanded for OC and FME. Meanwhile, further optimization of CAD algorithms, the education of gastroenterologists, and analysis of the interaction between the clinician and the computer should be performed.
食管腺癌（EAC）是全球癌症相关死亡的主要原因之一，其发病率正在上升。巴雷特食管（BE）可发展为低级别和高级别异型增生，随着时间的推移可进展为EAC。检测异型增生性BE（DBE）或EAC的金标准是根据西雅图方案进行高清白光内镜检查（HD-WLE）监测和随机活检。然而，这种方法耗时且漏诊率显著。因此，迫切需要开发新的可靠技术来优化监测策略并提高检出率。
与HD-WLE和随机活检相比，窄带成像等光学染色内镜（OC）技术在检测DBE和EAC方面表现更佳。包括iSCAN光学增强系统和联合彩色成像在内的最新OC技术在回顾性研究中显示出对DBE和EAC特征描述的改善。荧光分子内镜检查（FME）在突出显示DBE和EAC方面呈现出有前景的结果。此外，随着性能良好的轮廓计算机辅助检测（CAD）算法的建立以及首个用于EAC的实时CAD系统的出现，我们预计CAD在不久的将来会得到临床应用。
尽管先进内镜技术的发展取得了令人瞩目的进展，但联合HD-WLE/OC并随后进行随机活检仍然是BE监测的金标准。监测取决于适当的黏膜清洁、足够的检查时间以及执行检查的胃肠病学家的能力，以提高EAC的检出率。此外，为了促进先进内镜技术的临床应用，需要针对OC和FME开展多中心前瞻性临床研究。同时，应进一步优化CAD算法，对胃肠病学家进行培训，并分析临床医生与计算机之间的相互作用。
