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Oesophageal Glycogenic AcanthosisOesophageal Glycogenic AcanthosisOesophageal Glycogenic AcanthosisOesophageal Glycogenic AcanthosisOesophageal Glycogenic AcanthosisOesophageal Glycogenic AcanthosisOesophageal Glycogenic AcanthosisOesophageal Glycogenic AcanthosisOesophageal Glycogenic AcanthosisOesophageal Glycogenic AcanthosisOesophageal Glycogenic Acanthosis
ENDOSCOPIC ESOPHAGEAL IMAGES Ho Dang Quy Dung M.D Oesophageal Glycogenic Acanthosis Oesophageal Glycogenic Acanthosis Túi thừa Zenker Zenker´s diverticulum The first known picture of a Zenker´s diverticulum (the large sac to the left in the picture) in a woodcut published in a book by F A Zenker and H von Ziemssen, Handbuch der Krankenheiten des Chylopoetischen Apparates I, 1877 TUÙI THỪA THỰC QUẢN TÚI THỪA THỰC QUẢN Hẹp lành tính thực quản Endoscopic appearance of benign strictures Hẹp lành tính thực quản Endoscopic appearance of benign strictures Reflux Oesophagitis Savary-Miller Classification GRADE 1: On or several erosions in one mucosal fold GRADE 2: Several erosions in several mucosal folds, the erosions can merge GRADE 3: Erosions surrounding the the oesophageal circumference GRADE 4: Ulcer(s), strictures, shortening of the Oesophagus GRADE 5: Barrett´s Epithelium • Hetzel–Dent classification • MUSE classification: metaplasia (M), ulceration (U), stricture formation (S), and mucosal erosion (E) Each of these elements is graded independently in four increments (0, absent; 1, mild; 2, moderate; 4, severe) The result of an endoscopic examination is described as a grade for each lesion type, i.e M0U1S0E1 Scars after a Mallory Weiss lesion Mallory-Weiss lesion Definition of Barrett’s esophagus Is a premalignant metaplastic process where the normal squamous epithelium of the distal esophagus is replaced by columnar epithelium that is more resistant to acid and bile At endoscopy it is recognized by a displacement of the squamocolumnar junction, with segments of columnar epithelium extending proximally into the esophagus Normal squamocolumnar junction between esophagus Definition of Barrett’s esophagus Is a premalignant metaplastic process where the normal squamous epithelium of the distal esophagus is replaced by columnar epithelium that is more resistant to acid and bile At endoscopy it is recognized by a displacement of the squamocolumnar junction, with segments of columnar epithelium extending proximally into the esophagus Columnar epithelium Squamous epithelium Normal squamocolumnar junction between esophagus and stomach delimited by the black outline Definition of Barrett’s esophagus Is a premalignant metaplastic process where the normal squamous epithelium of the distal esophagus is replaced by columnar epithelium that is more resistant to acid and bile At endoscopy it is recognized by a displacement of the squamocolumnar junction, with segments of columnar epithelium extending proximally into the esophagus Columnar epithelium Squamous epithelium Normal squamocolumnar junction between esophagus and stomach delimited by the black outline Barrett’s esophagus Definition of Barrett’s esophagus Is a premalignant metaplastic process where the normal squamous epithelium of the distal esophagus is replaced by columnar epithelium that is more resistant to acid and bile At endoscopy it is recognized by a displacement of the squamocolumnar junction, with segments of columnar epithelium extending proximally into the esophagus Columnar epithelium Squamous epithelium Normal squamocolumnar junction between esophagus and stomach delimited by the black outline Barrett’s esophagus with displaced squamocolumnar junction delimited by the black outline Diagnosis of Barrett’s esophagus Barrett’s esophagus is a histologigal diagnosis The diagnosis of Barrett’s esophagus can only be achieved by endoscopy and biopsy of affected tissue Microscopic examination of tissue samples is mandatory to establish the diagnose and to monitor pre-malignant changes When the columnar epithelium extends cm or more into the distal esophagus it is called “long-segment” Barrett’s esophagus When extending less than cm it is designed as “short-segment” Barrett’s esophagus A direct correlation between the length of Barrett’s mucosa and duration of acid exposure has been described It seems that long segment BE predisposes more to cancer but current guidelines recommend managing both entities in the same manner Long segment Barrett’s esophagus The S-Q junction is not observed as it lies even more proximal Short segment Barrett’s esophagus with two small toungues extending proximally into the distal esophagus Barrett’s esophagus with early premalignant changes (arrow) Oesophageal Squamous (Squamocellular) Papilloma Early oesophageal squamocellular cancer Oesophageal Cancer Oesophageal Cancer