dysplasia | Acta Medica Marisiensis

Endoscopic Examination: a Present and Future Challenge

Boeriu Alina¹, Dobru Daniela¹, Mocan Simona², Pascarenco Ofelia³, Stoian M⁴, Boeriu C⁵

1 Department of Gastroenterology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Pathology, County Emergency Hospital, Tîrgu Mureș, Romania
3 Department of Gastroenterology, County Emergency Hospital, Tîrgu Mureș, Romania
4 Intensive Care Department, County Emergency Hospital, Tîrgu Mureș, Romania
5 Emergency Department, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

The detection and surveillance of patients with premalignant gastric lesions could lead to early detection and treatment of gastric cancer. These lesions are mostly diagnosed in random biopsy samples obtained during conventional endoscopy. New endoscopic techniques, such as magnification endoscopy, may help the detection of neoplastic lesions. In this case series, we intended to emphasize the current problems in the detection and surveillance of gastric neoplasic lesions in clinical practice. Four cases with gastritis-like appearance on conventional endoscopy were identified with gastric dysplasia or carcinoma on histopathologic evaluation. We discussed the subjective interpretation of endoscopic findings, the challenges in the surveillance of low-grade dysplasia and the contribution of magnifying endoscopy on diagnostic accuracy. The performance of endoscopic examination and surveillance could be improved by magnified chromoendoscopy with targeted biopsies. An understanding of diagnostic challenges of gastric dysplasia is crucial in clinical management.

The Usefulness of White Light Endoscopy, Narrow Band Imaging, and Magnification for the Optimization of Diagnosis in Barrett’s Esophagus

Boeriu Alina^1*, Brusnic Olga¹, Onișor Danusia¹, Pascarenco Ofelia¹, Boeriu C², Dobru Daniela¹

1 Department of Gastroenterology, University of Medicine and Pharmacy Tirgu Mures, Romania
2 University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures County Emergency Hospital, Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0002

The diagnosis of dysplasia and early neoplasia in Barrett’s esophagus by conventional endoscopy is based on a four- quadrant random biopsies protocol that is prone to sampling errors. Novel endoscopic techniques have been developed to enhance the detection of premalignant and malignant lesions by real time assessment of microvasculare architecture and mucosal structure. Chromoendoscopy with magnification has improved the visualization of lesions, but the dye application impairs a clear evaluation of vascular network. Narrow band imaging endoscopy enhances vascular imaging by using narrow bandwidth lights, with penetration to superficial mucosal structures. Different classification systems of mucosal and vascular patterns have been developed to improve the diagnostic accuracy of non-dysplastic and dysplastic BE, as well as of early esophageal cancer. This article is focused on both the clinical benefits and controversies surrounding conventional and advanced endoscopic methods used for screening and surveillance of patients with Barrett’s esophagus. Current evidence shows that the adoption of new technology in routine practice requires a high level of performance as well as the standardization of various classification systems.