Barrett's Esophagus. El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Enhanced magnification endoscopy. 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.

Video Endoscopic Sequence 1 of 9.

 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. 
Barrett Esophagus. Enhanced magnification Endoscopy. is a technique to identify specialized intestinal metaplasia in Barrett's 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.
Barrett Esophagus. Enhanced magnification endoscopy. Acetic acid-enhanced magnification endoscopy in the diagnosis of specialized intestinal metaplasia, dysplasia and early cancer in Barrett's oesophagus.

Video Endoscopic Sequence 3 of 9.

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.

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

Video Endoscopic Sequence 4 of 9.

 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 .
 
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. It 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.

Video Endoscopic Sequence 5 of 9.

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.

 It 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.
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.

Video Endoscopic Sequence 6 of 9.

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.

 
Chromoendoscopy using Lugol's solution. 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 artifact. 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.

Video Endoscopic Sequence 7 of 9.

 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 artifact.

 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.

 
18 months after the therapy with argon plasma coagulator APC. An endoscopic follow up. The tongues has been shortened.

Video Endoscopic Sequence 8 of 9.

A follow up endoscopy.

18 months after the therapy with argon plasma coagulator
(APC).

The tongues has been shortened.

A small remnant of the tongues. A new session of ablative therapy with Argon Plasma coagulator was performed.

Video Endoscopic Sequence 9 of 9.

A small remnant of the tongues.

A new session of ablative therapy with Argon Plasma coagulator was performed.
Para esophageal Hernia and Barrett Esophagus. This is the case of a 63 year-old woman that has been suffering of long-standing reflux disease.

Video Endoscopic Sequence 1 of 13.

Paraesophageal Hernia and Barrett Esophagus.

 This is the case of a 63 year-old woman that has been
 suffering of long-standing reflux disease.
Hiatal hernias may be classified into one of four types.Type I (sliding hiatal hernia) in which there is a migration of the esophago-gastric junction above the diaphragm into the thorax is the most common. Type II is a true paraesophageal hernia in which the stomach herniates into the thorax, but the esophago-gastric junction remains fixed in its normal anatomic location below the diaphragm. Type III (mixed paraesophageal hernia) is a combination of a sliding hiatal hernia with some or all of the stomach herniating above the esophago-gastric junction. Type IV are those hiatal hernias which include abdominal viscera and or solid organs within the hernia sac. Rarely, a parahiatal hernia, where gastric herniation occurs through a diaphragmatic defect separate from the hiatus, may be seen.

Video Endoscopic Sequence 2 of 13.

 Hiatal hernias may be classified into one of four types.
 Type I (sliding hiatal hernia) in which there is a migration
 of the esophago-gastric junction above the diaphragm into
 the thorax is the most common. Type II is a true
 paraesophageal hernia in which the stomach herniates into
 the thorax, but the esophago-gastric junction remains fixed
 in its normal anatomic location below the diaphragm. Type
 III (mixed paraesophageal hernia) is a combination of a
 sliding hiatal hernia with some or all of the stomach
 herniating above the esophago-gastric junction. Type IV
 are those hiatal hernias which include abdominal viscera
 and/or solid organs within the hernia sac. Rarely, a
 parahiatal hernia, where gastric herniation occurs through
 a diaphragmatic defect separate from the hiatus, may be
 seen.
Sliding hiatal hernia. The patient has also a complex hernia

Video Endoscopic Sequence 3 of 13.

Sliding hiatal hernia.

The patient has also a complex hiatal hernia
Barrett Esophagus. The Barrett's epithelium is recognizable as salmon colored esophageal mucosa that contrasts with the pearly white appearance of the normal esophageal squamous mucosa. The length of Barrett's epithelium is conventionally measured by subtracting the distance from the incisors to the squamocolumnar junction from the distance to the top of the gastric folds. The gastric folds are apparent here. The squamocolumnar junction is seen here.

Video Endoscopic Sequence 4 of 13.

Barrett Esophagus.

 The Barrett's epithelium is recognizable as salmon colored
 esophageal mucosa that contrasts with the pearly white
 appearance of the normal esophageal squamous mucosa.
 The length of Barrett's epithelium is conventionally
 measured by subtracting the distance from the incisors to
 the squamocolumnar junction from the distance to the top
 of the gastric folds. The gastric folds are apparent here.
 The squamocolumnar junction is seen here.
 

 
Tongues of Barrett's metaplasia.

Video Endoscopic Sequence 5 of 13.

Tongues of Barrett's metaplasia.

 
Inside the Paraesophageal hernia, there are fibers accumulated.

Video Endoscopic Sequence 6 of 13.

Inside the Paraesophageal hernia, there are fibers accumulated.
Endoscopic Ablation of Barrett's esophagus with argon plasma coagulator. Management of Barrett esophagus is still a clinical challenge Although the incidence of cancer appears to be low, occurring in 0.5% of patients with Barrett esophagus.

Video Endoscopic Sequence 7 of 13.

Endoscopic Ablation of Barrett's esophagus with argon plasma coagulator.

 Management of Barrett esophagus is still a clinical
 challenge Although the incidence of cancer appears to be
 low, occurring in 0.5% of patients with Barrett esophagus.
Argon plasma coagulation is one of several techniques used to ablate Barrett's esophagus.

Video Endoscopic Sequence 8 of 13.

Argon plasma coagulation is one of several techniques used to ablate Barrett's esophagus.

 
Endoscopic ablation of Barrett's esophagus using high power setting argon plasma coagulation 90 watts.

Video Endoscopic Sequence 9 of 13.

Endoscopic ablation of Barrett's esophagus using high power setting argon plasma coagulation 90 watts.

 
APC treatment of Barrett's esophagus is simple, efficacious and safe. Reversal of Barrett's mucosa can be achieved by a few endoscopic sessions. But long term follow-up studies on many patients are necessary to establish the frequency of endoscopic surveillance on the basis of recurrence or dysplasia evolution risk, in spite of APC treatment.

Video Endoscopic Sequence 10 of 13.

APC treatment of Barrett's esophagus is simple, efficacious and safe. Reversal of Barrett's mucosa can be achieved by a few endoscopic sessions. But long term follow-up studies on many patients are necessary to establish the frequency of endoscopic surveillance on the basis of recurrence or dysplasia evolution risk, in spite of APC treatment.

 
APC is a technique that delivers controlled monopolar electrocoagulation via a stream of ionized argon gas ignited by a high voltage discharged at the tip of a specialized flexible probe. It is a noncontact ablative method with a predetermined depth of injury (approximately 2 mm) that is most often used for coagulation of bleeding surfacelesions such as arteriovenous malformations.

Video Endoscopic Sequence 11 of 13.

 APC is a technique that delivers controlled monopolar
 electrocoagulation via a stream of ionized argon gas ignited
 by a high voltage discharged at the tip of a specialized
 flexible probe. It is a noncontact ablative method with a
 predetermined depth of injury (approximately 2 mm) that is
 most often used for coagulation of bleeding surface lesions
 such as arteriovenous malformations.
Ablative therapy The goal of ablative therapy is to destroy the Barrett epithelium to a sufficient depth to eliminate the intestinal metaplasia and allow regrowth of squamous epithelium. A number of modalities have been tried, e.g. photodynamic therapy, argon plasma coagulation, multipolar electrocoagulation and various forms of lasers. There is no direct evidence to suggest that there is a reduction in cancer risk in patients after mucosal ablation therapy. Long term outcomes have been disappointing in terms of relapse after treatment, but this form of treatment is still considered to offer the prospect of developing improved intervention for the future

Video Endoscopic Sequence 12 of 13.

 Ablative therapy. The goal of ablative therapy is to destroy
 the Barrett epithelium to a sufficient depth to eliminate the
 intestinal metaplasia and allow regrowth of squamous
 epithelium. A number of modalities have been tried, e.g.
 photodynamic therapy, argon plasma coagulation,
 multipolar electrocoagulation and various forms of lasers.
 There is no direct evidence to suggest that there is a
 reduction in cancer risk in patients after mucosal ablation
 therapy. Long term outcomes have been disappointing in
 terms of relapse after treatment, but this form of treatment
 is still considered to offer the prospect of developing
 improved intervention for the future.
A follow up endoscopy was performed six months after the APC ablation. Due to the APC ablation the tongues have been shortened, but there is a Barrett epithelium yet, a new session of APC will be programmed.

Video Endoscopic Sequence 13 of 13.

A follow up endoscopy was performed six months after the APC ablation.

 Due to the APC ablation the tongues have been shortened,
 but there is Barrett epithelium yet, a new session of APC
 will be programmed. 

Short segment of Barrett's Esophagus. 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).

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 barrettīs 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 .

Video Endoscopic Sequence 2 of 4.

 Treatment of short segment of Barrettīs 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 coagulation.

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.
A 60 year-old female, with longstanding gastroesophageal reflux disease. One year previously the patient underwent peroral intraluminal gastroplicature. The image and the video clip display three endoscopic gastroplictures. At this time the patient was underwent an upper endoscopy due to a Screening for Barrett's Esophagus.

Video Endoscopic Sequence 1 of 7.

 A 60 year-old female, with longstanding gastroesophageal
 reflux disease.
 One year previously the patient underwent peroral
 intraluminal gastroplicature.
 The image and the video clip display three endoscopic
 gastroplictures.
 At this time the patient was underwent an upper endoscopy
 due to a Screening for Barrett’s Esophagus.

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.

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

Video Endoscopic Sequence 3 of 7.

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

 
 
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 4 of 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).

 
 
 
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 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.

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 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.

Chromoendoscopy using methilene blue.

Video Endoscopic Sequence 7 of 7.

 Chromoendoscopy using methilene blue.
Barretīs 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 Barretīs esophagus was found.

Video Endoscopic Sequence 1 of 4.

          Barretīs 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
 Barretīs esophagus was found.

Another image and video of the Barretīs 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 valuation, we did not use a sedative, only local oropharingeal anesthesia.

Video Endoscopic Sequence 2 of 4.

 Another image and video of the Barretīs 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.
 
A hiatus hernia is observed in retroflexed maneuver. The patientīs furthermore symptoms that were described before are from a urinary tract infection and gallstones.

Video Endoscopic Sequence 3 of 4.

 A hiatus hernia is observed in retroflexed maneuver.
 The patientīs 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 a para-esophageal hernia is seen (retroflexed image).

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).
 

 

 

Barrettīs Esophagus. A 43 year-old male with long-standing gastroesophageal reflux. Biopsies confirmed the presence of intestinal metaplasia. Biopsies obtained just below the squamocolumnar junction reveled specialized metaplastic epithelium with goblet cells (intestinal metaplasia). The video clips of this sequence display reflux esophagitis.

Video Endoscopic Sequence 1 de 2.

Barrettīs Esophagus.

 A 43 year-old male with long-standing gastroesophageal
 reflux. Biopsies confirmed the presence of intestinal
 metaplasia.
 Biopsies obtained just below the squamocolumnar
 junction reveled specialized metaplastic epithelium with
 goblet cells (intestinal metaplasia).
 The video clips of this sequence display reflux esophagitis.
    
   
Barrettīs Esophagus. Retroflexed image looking upward at the GI junction.

Video Endoscopic Sequence 2 de 2.

 Barrettīs Esophagus.

 Retroflexed image looking upward at the GI junction.      
Long segment of Barrettīs Esophagus. A 90 year-old male with a long history of reflux disease. The endoscopy, demonstrated a long segment of Barrettīs esophagus confirmed hystopatologically

 Long Segment of Barrettīs Esophagus.

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

Barrettīs 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.

Video Endoscopic Sequence 1 of 4.

 Barrettīs 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.   
    

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

Video Endoscopic Sequence 2 of 4.

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

Video Endoscopic Sequence 3 of 4.

 A hyperplasic polyp is observed, some biopsies were
 taken.
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.

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. 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.

 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.