Polyp identification and marking: Chromoscopy, high-resolution and high-magnification endoscopy, tattooing, and clipping

Advances in gastrointestinal endoscopic techniques

An increasing number of techniques for endoscopic diagnosis and treatment is being described. Endoscopic surgeons should be familiar with these techniques. Although many of the diagnostic techniques, other than marking, do not have widespread clinical application, the therapeutic techniques that were described in this article are being used successfully in increasing numbers of appropriately selected patients. Additional experience and technologic advances will refine the endoscopic therapy that is available to patients with colorectal diseases.

Interventional endoscopy in the diagnosis and staging of upper gastrointestinal malignancy

Increased population longevity as well as an emphasis on earlier diagnosis and more effective treatment of cancer have created an environment for new technologies and techniques to flourish. Some of the endoscopic entities discussed in this article have not been fully validated in clinical practice. Innovative spectroscopic modalities hold a great deal of promise, but are years away from general applicability. In contrast, many interventional endoscopic techniques are currently available and confer heightened levels of diagnostic and staging accuracy for gastric and esophageal malignancies. Earlier diagnosis can identify patients who may be eligible for less-invasive treatment options such as EMR. Minimally invasive treatment options and maximum staging accuracy are more important for patients who are marginal surgical candidates and for accurate comparison of clinical trials studying treatment options. Our challenge for the future is to properly integrate these technologic advances with the science of good medical practice.

Endoscopic and histologic diagnosis of Barrett esophagus

Endoscopy plays an important role in the identification, diagnosis, and treatment of Barrett esophagus. Short-segment (<2-3 cm) and traditional long-segment (>2-3 cm) Barrett esophagus are distinguished solely on the length of metaplastic tissue above the esophagogastric junction. The histologic hallmark of intestinal metaplasia is required to confirm diagnosis. Biopsy specimens obtained from tissue of presumed Barrett esophagus or an irregular Z line confirm metaplastic glandular mucosa and permit evaluation of dysplastic or neoplastic changes. In the appropriate clinical setting, the use of adjunctive diagnostic techniques may facilitate the diagnosis of Barrett esophagus and sequelae such as dysplasia. Chromoendoscopy with high-resolution or magnified endoscopy is simple, safe, and desirable for surveillance but requires additional procedural time. The use of light-induced fluorescence endoscopy and light-scattering spectroscopy (i.e., optical biopsy) is appealing for the diagnosis and characterization of suspicious lesions. Adjunctive endoscopic techniques and adherence to a protocol for performing biopsies facilitate the early detection and subsequent surveillance of Barrett esophagus.