{"title":"Magnifying Endoscopic Classification for Early Barrett's Neoplasia.","authors":"Yohei Ikenoyama, Aiji Hattori, Yasuko Fujiwara, Misaki Nakamura, Yasuhiko Hamada, Noriyuki Horiki, Hayato Nakagawa","doi":"10.1159/000548227","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Barrett's esophagus (BE) is becoming increasingly prevalent in both Western countries and Japan. Early diagnosis of Barrett's neoplasia remains challenging. Traditionally, the Seattle protocol, a four-quadrant random biopsy method, has been recommended in Western guidelines. However, this approach has several limitations, including sampling errors, poor adherence, and a high procedural burden. Therefore, magnifying endoscopy has gained attention as a valuable tool for detecting and characterizing neoplastic lesions in patients with BE.</p><p><strong>Summary: </strong>This review outlines historical and current developments in magnifying endoscopic classification systems for BE, with a focus on narrow-band imaging (NBI) and acetic acid chromoendoscopy in both Western countries and Japan. Although various NBI-based classifications have been proposed, their complexity and poor reproducibility have limited their widespread clinical adoption. Recently, simplified and standardized classification systems, including the Barrett's International NBI Group classification in the West and the Japan Esophageal Society-Barrett's esophagus classification in Japan, have been introduced. These systems adopt a binary framework, categorizing mucosal and vascular patterns as \"regular\" (non-neoplastic) or \"irregular\" (neoplastic). They are easy to apply and have demonstrated high diagnostic accuracy and substantial interobserver agreement. Further simplification and practical refinement are required for broader clinical implementation.</p><p><strong>Key messages: </strong>Compared with other gastrointestinal cancers, the magnifying endoscopic diagnosis of Barrett's neoplasia remains technically demanding. However, based on a growing body of evidence, endoscopists should be encouraged to actively challenge this area. Continued efforts to simplify and validate the classification systems are essential for their widespread clinical use in BE surveillance.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-11"},"PeriodicalIF":3.6000,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Digestion","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000548227","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Barrett's esophagus (BE) is becoming increasingly prevalent in both Western countries and Japan. Early diagnosis of Barrett's neoplasia remains challenging. Traditionally, the Seattle protocol, a four-quadrant random biopsy method, has been recommended in Western guidelines. However, this approach has several limitations, including sampling errors, poor adherence, and a high procedural burden. Therefore, magnifying endoscopy has gained attention as a valuable tool for detecting and characterizing neoplastic lesions in patients with BE.
Summary: This review outlines historical and current developments in magnifying endoscopic classification systems for BE, with a focus on narrow-band imaging (NBI) and acetic acid chromoendoscopy in both Western countries and Japan. Although various NBI-based classifications have been proposed, their complexity and poor reproducibility have limited their widespread clinical adoption. Recently, simplified and standardized classification systems, including the Barrett's International NBI Group classification in the West and the Japan Esophageal Society-Barrett's esophagus classification in Japan, have been introduced. These systems adopt a binary framework, categorizing mucosal and vascular patterns as "regular" (non-neoplastic) or "irregular" (neoplastic). They are easy to apply and have demonstrated high diagnostic accuracy and substantial interobserver agreement. Further simplification and practical refinement are required for broader clinical implementation.
Key messages: Compared with other gastrointestinal cancers, the magnifying endoscopic diagnosis of Barrett's neoplasia remains technically demanding. However, based on a growing body of evidence, endoscopists should be encouraged to actively challenge this area. Continued efforts to simplify and validate the classification systems are essential for their widespread clinical use in BE surveillance.
背景:巴雷特食管(BE)在西方国家和日本越来越普遍。巴雷特瘤的早期诊断仍然具有挑战性。传统上,西雅图协议,四象限随机活检方法,已被推荐在西方指南。然而,这种方法有一些局限性,包括抽样误差、较差的依从性和较高的程序负担。因此,放大内窥镜作为一种检测和表征BE患者肿瘤病变的有价值的工具而受到关注。摘要:本文概述了BE的放大内镜分类系统的历史和当前发展,重点介绍了西方国家和日本的窄带成像(NBI)和醋酸色内镜。尽管已经提出了各种基于nbi的分类,但它们的复杂性和较差的可重复性限制了它们在临床的广泛应用。近年来,西方的Barrett's International NBI Group分类法和日本食管学会-Barrett's食管分类法等简化、标准化的分类体系相继问世。这些系统采用二元框架,将粘膜和血管模式分为“规则”(非肿瘤性)和“不规则”(肿瘤性)。它们易于应用,并表现出较高的诊断准确性和大量的观察者之间的一致性。为了更广泛的临床应用,需要进一步简化和实际改进。关键信息:与其他胃肠道肿瘤相比,巴雷特瘤的放大内镜诊断技术要求较高。然而,基于越来越多的证据,应该鼓励内窥镜医师积极挑战这一领域。继续努力简化和验证分类系统对其在BE监测中的广泛临床应用至关重要。
期刊介绍:
''Digestion'' concentrates on clinical research reports: in addition to editorials and reviews, the journal features sections on Stomach/Esophagus, Bowel, Neuro-Gastroenterology, Liver/Bile, Pancreas, Metabolism/Nutrition and Gastrointestinal Oncology. Papers cover physiology in humans, metabolic studies and clinical work on the etiology, diagnosis, and therapy of human diseases. It is thus especially cut out for gastroenterologists employed in hospitals and outpatient units. Moreover, the journal''s coverage of studies on the metabolism and effects of therapeutic drugs carries considerable value for clinicians and investigators beyond the immediate field of gastroenterology.