Barrett Esophagus
Endoscopic view of Barrett Esophagus.

Video Endoscopic Sequence 1 of 9.

Endoscopic view of Barrett Esophagus.

A 53 year-old male with long standing GERD.

The mean age of development of Barrett's esophagus is estimated to be 40 years, yet the mean age at diagnosis is 63 years.

This suggests that a premalignant disorder may be present for up to 20 years before it is clinically recognized.

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All endoscopic images shown in this Atlas contain video clips. We recommend seeing the video clips in full screen mode.






Barrett Esophagus.

Video Endoscopic Sequence 2 of 9.

Barrett Esophagus.

Enhanced magnification endoscopy.

Enhanced magnification endoscopy is a technique to identify specialized intestinal metaplasia in Barrett's esophagus.

 

   Medline.

Endoscopy of Barrett Esophagus.

Video Endoscopic Sequence 3 of 9.

Endoscopy of Barrett Esophagus.

Enhanced magnification endoscopy.

Acetic acid-enhanced magnification endoscopy in the diagnosis of specialized intestinal metaplasia, dysplasia and early cancer in Barrett's esophagus.

 

 



Endoscopic view of Barrett Esophagus.

Video Endoscopic Sequence 4 of 9.

Endoscopic view of Barrett Esophagus.

Enhanced magnification endoscopy is an accurate method of predicting Specialized intestinal metaplasia in Barrett's esophagus.

The simplicity of the technique and its ability to identify characteristic endoscopic patterns with outstanding clarity and resolution that correlate with histologic identification of specialized intestinal metaplasia make enhanced magnification endoscopy an excellent method for the evaluation of patients with Barrett's esophagus.




Endoscopic view of Barrett Esophagus.

Video Endoscopic Sequence 5 of 9.

Endoscopic view of Barrett Esophagus.

Chromoendoscopy using Lugol's solution.

Staining of the mucosa with Lugol's solution during endoscopy has been suggested to identify early cancer and dysplasia that may improve prognosis.

IIt has been shown that 40-60% of patients with typical reflux symptoms have no esophageal mucosal injury.
Lugol chromoendoscopy may be useful for the diagnosis of so-called endoscopy-negative GERD.




Endoscopic view of Barrett Esophagus.

Video Endoscopic Sequence 6 of 9.

Endoscopic view of Barrett Esophagus.

Chromoendoscopy using Lugol's solution.

Lugol's solution is an absorptive staining.

Lugol chromoendoscopy has been used to detect early esophageal cancer, which is difficult to recognize by routine observation without dye staining.

Using modern high-resolution videoendoscopy remarkable improvements in the visualization of fine epitelial details habe been made possible.

Enhancement of the epithelial surface can be achieved by additional staining. Vital staining and chromoendosocpy are synonymous for the same techniques. In combination with technical progress, the development of magnifying endoscopes, chromoendoscopy gains a considerable importance.


Endoscopic view of Barrett Esophagus.

Video Endoscopic Sequence 7 of 9.

Endoscopic view of Barrett Esophagus.

Some biopsies were taken with jumbo forceps. The use of the larger 3.4 mm forceps results in larger biopsies than the standard 2.4 mm biopsy forceps, and they are therefore best for diagnostic purposes.

The larger specimens obtained with these forceps are easier to orient and have proportionately less crush artifacto.

Vital staining of epithelial structures dates back to Schiller (1933) and originated with the use of Lugol’s solution (iodine solution) for diagnosis of neoplasias on the uterine cervix.

For tumors of the esophagus staining techniques were used already in the 1960’s and 70’s since they improved the endoscopic image.


Endoscopic view of Barrett Esophagus.

Video Endoscopic Sequence 8 de 9.

Endoscopic view of Barrett Esophagus.

 A follow up endoscopy.

18 months after the therapy with argon plasma coagulator (APC).
The tongues has been shortened.
















 

 

 

 

Endoscopic view of Barrett Esophagus.

Video Endoscopic Sequence 9 of 9.

Endoscopic view of Barrett Esophagus.

A small remnant of the tongues.

A new session of ablative therapy with Argon Plasma coagulator was performed.



 

Barrett's Esophagus short segment

Video Endoscopic Sequence 1 of 4.

Barrett's Esophagus "short segment".

Traditionally, Barrett's esophagus was defined as the presence of columnar mucosa extending >/= 3 cm into the tubular esophagus.

This definition has evolved into the presence of any specialized columnar epithelium in the esophagus as it became known that the presence of intestinal metaplasia of any length was associated with an increased risk of esophageal adenocarcinoma.

Barrett's esophagus was simply referred to as short-segment (< 3 cm) or long-segment (>/= 3 cm).




Medline.

Treatment of short segment of Barrett´s esophagus with

Video Endoscopic Sequence 2 of 4.

Treatment of short segment of Barrett´s esophagus with APC of high-frequency current coagulation.

There has been a recent focus on "short segment" Barrett's esophagus--intestinal metaplasia in the distal esophagus <3 cm in length.

Short segment Barrett's esophagus needs to be distinguished from intestinal metaplasia of the gastric cardia, a lesion of the stomach that cannot be seen on routine endoscopy, with less well defined epidemiology and significance


APC is a method of contact-free high-frequency current

Video Endoscopic Sequence 3 of 4.

APC is a method of contact-free high-frequency current coagulation.

Status post APC.

Video Endoscopic Sequence 4 of 4.

Status post APC.

Video Endoscopic Sequence 1 of 7.

A 60 year-old female, with longstanding gastroesophagealreflux disease

One year previously the patient underwent peroralintraluminal gastroplicature.

The image and the video clip display three endoscopicgastroplictures.
At this time the patient was underwent an upper endoscopydue to a Screening for Barrett’s Esophagus


 



 

 

Video Endoscopic Sequence 2 of 7.

Glycogenic acanthosis of the esophagus. This condition is asymptomatic and an incidental finding. These nodules or plaques result from accumulation of excess glycogen in mature squamous cells of the upper epithelium.

Glycogenic acanthosis of the esophagus and gastroesophageal reflux Although its etiology and pathogenesis still remain elusive, glycogenic acanthosis may be related to gastroesophageal reflux.

Esta entidad es asintomática y es un hallazgo incidental
Los nódulos o placas son el resultado de la acumulación
exceso de glicógeno en las células escamosas maduras
del epitelio. 
 



Video Endoscopic Sequence 3 of 7.

A nodule of Esophageal Glycogenic Acanthosis is
appreciated using a magnifying endoscope.


Video Endoscopic Sequence 4 de 7.

This image and the video clip is observed with a magnifying
endoscope.

The image and the video clip display the lining between
the esophagus and the stomach, the gastroesophagic
junction. The squamous epitelium (esophagus) lining with
columnar epithelium (stomach).



Video Endoscopic Sequence 5 of 7.

 Barrett’s esophagus short segment. High magnification
 image.

The gastroesophagic junction (Squamocolumnar junction) is observed, the microvillis are appreciated that are similar to the microvillis of the duodenum (presence of intestinal metaplasia). confirmed on biopsy.
The presence of intestinal metaplasia in the columnar lined distal esophagus defines Barrett's esophagus with the risk of future malignant transformation.

During endoscopic examination, the appearance of the esophagogastric junctionis carefully inspected (EGJ; defined as the junction of the proximal gastric folds and the tubular esophagus).

The squamocolumnar junction was also identified as the point where the squamous mucosa joined the salmon-color columnar mucosa.





Video Endoscopic Sequence 6 of 7.

Magnification images could help target areas of high yield
within Barrett’s mucosa would be helpful to identify high
yield areas, potentially eliminating the need for random
biopsies.





Video Endoscopic Sequence 7 of 7.

 Chromoendoscopy using methilene blue.


Endoscopic view of Barrett Esophagus

Video Endoscopic Sequence 1 of 2.

Endoscopic view of Barrett Esophagus.

This is a 43 year-old male with long standing gastroesophageal reflux. Biopsies confirmed the presence of intestinal metaplasia.
Biopsies obtained just above the junction revealed squamous epithelium metaplastic Paneth cells (intestinal metaplasia).
The video clips in this sequence also show reflux esophagitis.



Endoscopic view of Barrett Esophagus.

Video Endoscopic Sequence  2 of 2.

Endoscopic view of Barrett Esophagus.

Retroflexed image looking upward at the GI junction.    

Long Segment of Barrett´s Esophagus.

Long Segment of Barrett´s Esophagus.

A 90 year-old male with a long history of reflux disease. The endoscopy, demonstrated a long segment of Barrett´s esophagus confirmed histopatologically.

Barret´s Esophagus long segment.

Video Endoscopic Sequence 1 of 4.

 Barret´s Esophagus long segment.

A 106 year-old female, who presented abdominal pain, anorexia and long standing gastroesophageal reflux disease.
An upper endoscopic evaluation was performed. A big hiatus hernia, para-esophageal hernia and long segment Barret´s esophagus was found.

Barret´s Esophagus

Video Endoscopic Sequence 2 of 4.  

Another image and video of the Barret´s Esophagus

The patient’s birth date is displayed in the endoscopic image; May 5, 1897. With her 106 years of age, she displayed an unremarkable mental status and sense of humor. She is the oldest patient that we ever have attended. She drank a glass of red wine every day.

To perform the endoscopic evaluation, we did not use a sedative, only local oropharingeal anesthesia.




hiatus hernia

Video Endoscopic Sequence 3 of 4.

A hiatus hernia is observed in retroflexed maneuver. The patient´s furthermore symptoms that were described before are from a urinary tract infection and gallstones.

To the right, a hiatus hernia is observed, and to the left

Video Endoscopic Sequence 4 of 4.

To the right, a hiatus hernia is observed, and to the left a para-esophageal hernia is seen (retroflexed image).

 

Barrett´s Esophagus with new squamocolumnar junction found it very high level in the esophagus

Video Endoscopic Sequence 1 of 4.

Endoscopic view of Barrett Esophagus.

Barrett´s Esophagus with new squamocolumnar junction found it very high level in the esophagus. A 90 year-old male with long standing reflux disease presented a big hiatal hernia, 10 years previously we performed a endoscopy and found a reflux esophagitis Grade III.

The images and videos display a very long segment of
gastric mucosa (pink) into the esophagus See the video
clip. 

Endoscopic view of Barrett Esophagus.

Video Endoscopic Sequence  2 of 4.

Endoscopic view of Barrett Esophagus.

A retractile area is observed some biopsies were taken A small adenocarcinoma was found at this site.

 




Endoscopic view of Barrett Esophagus

  Video Endoscopic Sequence 3 of 4.

Endoscopic view of Barrett Esophagus

A hyperplasic polyp is observed, some biopsies were
taken.


Video Endoscopic Sequence  4 of 4.

50 years ago, he ingested some substance and suffered
larynx burn after that he presented dysphonia.
A granuloma is observed at left of the image.


Barrett's Ulcer.

Video Endoscopic Sequence 1 of 5.

Barrett's Ulcer.

A 70 year-old female with dysphagia.

Benign ulcer arising in the distal esophagus with Barrett's
disease short segment. The biopsies resulted with
intestinal metaplasia


Video Endoscopic Sequence 2 of 5.

There are an ulcer with fibrin and granulation tissue.

Video Endoscopic Sequence 3 of 5.

This image shows the intestinal metaplastic change of the
distal mucosa of the esophagus.

Video Endoscopic Sequence 4 of 5.

This image shows details of intestinal metaplasia, including
goblet cells and paneth cells.

Video Endoscopic Sequence 5 of 5.

This image shows the above mentioned with more
 magnifying.

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