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Herkenning van vroege vormen van kanker in Barrett slokdarm:

By A.A.J. de Rotte


Introduction: Adenocarcinoma of the oesophagus is one of the most increasing types of cancer in western world. Adenocarcinoma of the oesophagus is the result of Barrett’s oesophagus, in which squamous epithelium is replaced by columnar epithelium in combination with gastro-intestinal metaplasia. Due to the late recognition of oesophagus cancer, the prognosis is often poor. In The Netherlands surveillance of the Barrett’s oesophagus is well practiced and consists of endoscopy with biopsy for histological examination. Recently there have been different developments in endoscopy. One of these is the virtual chromo-endoscopy, which is based on the principal that light of short wavelengths reflects in the more superficial tissue and light of larger wavelengths reflecting in deeper tissue. The overall idea is that this will be helpful for diagnosis of lesions. In the present research we investigated the role of de Fuji Intelligent Chromo Endoscopy (FICE - Fujinon), one of the virtual chromo-endoscopy techniques. Materials and methods: We derived a test with two series of 12 images, one with images from white light endoscopy and one with the same images combined with images from FICE. 15 gastro-enterologists were asked to differentiate the images in the four stadia of Barrett’s oesophagus (intestinal metaplasia, low-grade dysplasia, high-grade dysplasia and adenocarcinoma). Additionally they were asked to note how sure they were and what determined their decision. Results: It seemed to be hard to differentiate the series of pictures, mainly because most gastro-enterologists were not used to use this differentiation. Despite that the answers did correlate significantly well with the histological examinations. The gastro-enterologists seemed to focus mainly on dichotomy in differentiation between intestinal metaplasia and low-grade dysplasia on one side and high-grade dysplasia and adenocarcinoma on the other side. The main added value is found in the high-grade dysplasia. Which is supported by an increased differentiation between high-grade dysplasia and adenocarcinoma. Conclusion: The FICE seems to be a helpful technique when determining the stage of Barrett’s oesophagus mainly in the critical zone of low-grade and high-grade dysplasia and also for differentiating high-grade dysplasia and adenocarcinoma. The most gaining factor in this is the visualisation of the vascular system in the oesophagus.

Year: 2011
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