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Esophageal Case 2

Prof. Stefan Seewald​

GastroZentrum Hirslanden, Zurich

Procedure Information


Scope:GIF-EZ1500

Case: Early Barrett’s cancer (pT1m3 L0 V0 Pn0 G2 R0)

Organ: Esophagus

Patient information: M, 76

Medical history: Heartburn

1. TXI

#TXI Mode 1 #A7 structure enhancement #Auto Iris

With TXI, a broader area of the Barrett appears with enhanced redding of the mucosa suggesting a higher vessel density.

2. NBI

#NBI #NBI Color Mode 1 #B7 structure Enhancement #Auto Iris

NBI in normal focus suggests irregularities in mucosal and vascular pattern.

3. Near focus with NBI

#NBI #NBI Color Mode 1 #B7 Structure Enhancement #Zoom Mode 2 #Auto Iris

Irregular vascular pattern, characteristic for Barrett‘s carcinoma.

4. Near Focus with TXI

#TXI Mode 1 #A7 structure enhancement #Auto Iris

With TXI, an irregular surface pattern can be observed.

5. TXI

#TXI Mode 1 #A7 structure enhancement #Auto Iris

The difference in surface between he upper an lower part of the lesion is easy to observe. An enhanced reddening accompanied by depression at 11 o‘clock indicates the most advanced area.

6. Near focus with NBI

#NBI #NBI Color Mode 1 #B7 Structure Enhancement #Zoom Mode 2 #Auto Iris

Near focus with NBI and 1.6x electronic zoom under water visualizes irregular vessel and surface structure which are characteristic for Barrett‘s carcinoma.

7. Acetic acid

#TXI Mode 1 #A7 structure enhancement #Auto Iris

Acetic acid was applied to estimate the margins of the lesion

8. Acetic acid with TXI

#TXI Mode 1 #A7 structure enhancement #Auto Iris

With TXI, a larger extent than anticipated with WLI+acetic acid is suspected.

9. Indigocarmine staining

#WLI #A7 structure enhancement #Auto Iris

To further delineate the lesion, indigo carmine was applied. Under WLI, an indistinct non-stained area spreads from 10 to 2 o‘clock.

10. Indigocarmine + TXI

#TXI Mode 1 #A7 structure enhancement #Auto Iris

Adding TXI to indigo carmine is providing an excellent delineation of this lesion.

Case video

Overall Comment

In this complex case, the combination of TXI, NBI and chromoendoscopy was helpful for a proper diagnosis and precise delineation.

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