Esophageal Case 2
Prof. Stefan Seewald
GastroZentrum Hirslanden, Zurich
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
With TXI, a broader area of the Barrett appears with enhanced redding of the mucosa suggesting a higher vessel density.
2. NBI
NBI in normal focus suggests irregularities in mucosal and vascular pattern.
3. Near focus with NBI
Irregular vascular pattern, characteristic for Barrett‘s carcinoma.
4. Near Focus with TXI
With TXI, an irregular surface pattern can be observed.
5. TXI
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
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
Acetic acid was applied to estimate the margins of the lesion
8. Acetic acid with TXI
With TXI, a larger extent than anticipated with WLI+acetic acid is suspected.
9. Indigocarmine staining
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
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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