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1. Introduction

In Western populations, patients with esophageal adenocarcinoma (EAC) derived from Barrett’s esophagus (BE) have shown a marked increase in recent decades. Furthermore, the clinical outcome of EAC has been reported that the prognosis worsens as the stage progresses, although a 5-year survival is around 47% for localized EAC [1,2,3,4]. The annual incidence of EAC arising from BE has reported to be 0.33% in a meta-analysis [5], and 0.36% in a prospective study [6]. Desai M at al. reported there was a significant increase in the detection of high-grade dysplasia and EAC (1990–1994, 5.1%; to 2005–2009, 6.3%; and 2010+, 16.3%) [7]. Thus, calculated rates of incidence of neoplastic progression in BE cases have never shown a reduction, this been suggested that endoscopic surveillance is essentially required for affected patients, as stated in guidelines presented by the British Society of Gastroenterology and American Colleague of Gastroenterology [8,9]. The American Society for Gastrointestinal Endoscopy (ASGE) standard of practice committee has reported that most patients with EAC are diagnosed in a later stage of the disease and performance of BE surveillance is associated with a 25% reduction in mortality [10]. However, endoscopic surveillance of BE is considered to be laborious and costly, as the protocol requires obtaining several biopsy specimens from quadrant areas, each with a 1 or 2 cm interval. Therefore, a more effective and simpler endoscopic surveillance method for clinical practice is anticipated to assist management of patients with BE.

Understanding of available information regarding the potential of neoplastic progression in BE prior to endoscopic surveillance is inevitably important. While several clinical risk factors, such as male gender, aging, smoking, high-fat diet, obesity, reflux esophagitis, colon neoplasms, as well as others, are well-known important predictors of Barrett’s carcinogenesis [11,12,13,14,15,16,17,18], they are not considered to be fully reliable indicators of neoplastic progression in all patients with BE. However, presence of erosive esophagitis or recurrent gastroesophageal reflux disease (GERD) symptom have been reported to be important predictors for neoplastic progression in BE as described below [19,20], and subsequently, proton pump inhibitor (PPI) use was protective against the progression [12,21,22]. Recently, biomarkers including epigenetics and miRNA analysis findings, DNA content abnormalities, and loss of heterozygosity noted in biopsy findings have been reported to be additional reliable predictors of malignant transformation in affected patients [23]. One of the most important biomarkers is aberrant expression and/or mutation of p53 [24,25]. Some of these biomarkers become to be detectable by specialized endoscopic devices such as autofluorescence endoscopy, optical coherence tomography, endocytoscopy, confocal endomicroscopy, or near-infrared imaging endoscopy, although use of these novel markers is difficult in clinical settings because of the complicated biochemical procedures required. On the other hand, various findings obtained with white light endoscopy (WLE), such as length of BE segment and presence of esophagitis, ulceration, and hiatal hernia, along with others, can be used for prediction of progression to EAC. Nevertheless, such endoscopic findings must be verified for use in clinical practice before being considered available as a true marker for neoplastic progression. Another significant factor related to Barrett’s carcinogenesis is cyclooxynase-2 (COX-2) protein expression, which has been reported to be a key event in transformation to a dysplastic lesion [26]. Endoscopic information regarding COX-2 protein expression in BE case can be detected by some endoscopic methods including chromoendoscopy or narrow band imaging (NBI) endoscopy, thus endoscopic surveillance may become to be a more efficacious by the use of these developed devices.

With the development of endoscopic methods and devices, the easier detection of neoplastic lesions of BE may be currently applicable for the clinical practice. Among them, NBI endoscopy that can be evaluated micro-mucosal and micro-vascular patterns is considered to be one of the representative candidates. In the present review, the contributions of endoscopic findings including WLE and image-enhanced endoscopy (IEE): chromoendoscopy, acetate-enhanced endoscopy, NBI endoscopy, and molecular imaging endoscopy, for prediction of the malignant potential of BE, were investigated. Furthermore, a new concept for efficient endoscopic surveillance of BE along with a targeting biopsy method instead of a random biopsy procedure is also discussed. Findings presented in this review were obtained with procedures conducted in accordance with the Declaration of Helsinki.

This entry is adapted from the peer-reviewed paper 10.3390/life10100244