Advances in imaging and endoscopic therapy in Barrett’s esophagus

This thesis evaluated the role of advanced imaging around endoscopic therapy as well as explored the further possibilities of endoscopic therapy of early neoplasia (i.e. high-grade dysplasia and early cancer) in Barrett's esophagus. Advanced imaging techniques such as autofluorescence and narrow-band imaging appeared to have a limited value in daily practice. Consequently, biopsying areas that are suspected to harbor neoplasia or intestinal metaplasia is more practical and results in a more accurate diagnosis when inspecting a Barrett's esophagus. In endoscopic therapy new advances were made: endoscopic therapy is possible for very long segment Barrett's esophagus ( >10cm) , large lesions ( >2cm in length or more than >50% of the circumference) or when a low risk submucosal cancer is encountered. In addition, multi-band mucosectomy, a relatively new endoscopic resection technique, resulted to be safe and effective. Finally, a porcine model was initiated to explore the challenges encountered in endoscopic therapy, such as stenosis after extensive endoscopic resection. Stenosis formation did not appear to be affected by botulin or steroid injections in our porcine model.