Techniques in Gastrointestinal Endoscopy RSS feed: Current Issue. The purpose of each issue of Techniques in Gastrointestinal Endoscopy is to provide a comprehensive, current overview of a clinical condition or surgical procedure in gastrointestinal endoscopy, combining the effectiveness of an atlas with the timeliness of a journal. Each issue places a vigorous emphasis on diagnosis, rationale for and against a procedure, actual technique, management, and prevention of complications. The journal features abundant illustrations, line drawings and color artwork to guide readers through even the most complicated procedure. 2009 Topics , Vol. 11, Issues 1-4 January Interface of ERCP and EUS for Pancreaticobiliary Pathology Steve Edmundowicz April NOTES in Clincial Application Anthony Kalloo July Management of Pulmonary Complications of GI Disease Dan Sterman October Endoscopic Management of Esophageal Strictures Todd H. Baronhttp://www.techgiendoscopy.com/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Techniques in Gastrointestinal Endoscopy1096-2883122April 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.techgiendoscopy.com/article/PIIS1096288310000343/abstract?rss=yesCover10.1016/S1096-2883(10)00034-3Techniques in Gastrointestinal Endoscopy 12, 2 (2010)2010-04-01Techniques in Gastrointestinal Endoscopy2010-04-01122S1096-2883(10)X0003-1OFCOFChttp://www.techgiendoscopy.com/article/PIIS1096288310000355/abstract?rss=yesMasthead10.1016/S1096-2883(10)00035-5Techniques in Gastrointestinal Endoscopy 12, 2 (2010)2010-04-01Techniques in Gastrointestinal Endoscopy2010-04-01122S1096-2883(10)X0003-1IFCIFChttp://www.techgiendoscopy.com/article/PIIS1096288310000367/abstract?rss=yesEditorial Board10.1016/S1096-2883(10)00036-7Techniques in Gastrointestinal Endoscopy 12, 2 (2010)2010-04-01Techniques in Gastrointestinal Endoscopy2010-04-01122S1096-2883(10)X0003-1iihttp://www.techgiendoscopy.com/article/PIIS1096288310000379/abstract?rss=yesTable of Contents10.1016/S1096-2883(10)00037-9Techniques in Gastrointestinal Endoscopy 12, 2 (2010)2010-04-01Techniques in Gastrointestinal Endoscopy2010-04-01122S1096-2883(10)X0003-1iiiihttp://www.techgiendoscopy.com/article/PIIS1096288310000124/abstract?rss=yesBarrett's esophagus is an acquired condition resulting from severe esophageal mucosal injury. It is a disease that would be of little importance if not for its well-recognized association with adenocarcinoma of the esophagus. The incidence of esophageal adenocarcinoma continues to increase in the Western world, and the 5-year survival rate for this cancer remains dismal. Current strategies for improved survival in patients with esophageal adenocarcinoma focus on cancer detection at an early and potentially curable stage. This can be accomplished either by screening more patients for Barrett's esophagus or with endoscopic surveillance of patients with known Barrett's esophagus. However, current screening and surveillance strategies are inherently expensive, inefficient, and of unproven benefit. New techniques to improve the efficiency of cancer surveillance continue to evolve and hold promise to change clinical practice in the future. Endoscopic approaches to therapy of Barrett's esophagus and early esophageal cancer are advancing at a rapid and exciting pace as well.IntroductionGary W. Falk10.1016/j.tgie.2010.02.001Techniques in Gastrointestinal Endoscopy 12, 2 (2010)2010-04-01Techniques in Gastrointestinal Endoscopy2010-04-01122S1096-2883(10)X0003-16161http://www.techgiendoscopy.com/article/PIIS1096288310000203/abstract?rss=yesBarrett's esophagus (BE) increases the risk for development of esophageal adenocarcinoma. Because of the rapid rise in incidence of esophageal adenocarcinoma, screening for BE with subsequent surveillance when found has been proposed as a method of early detection. Sedated endoscopy, however, is too expensive for widespread screening. As a result, other techniques, including unsedated transnasal esophagoscopy and capsule esophagoscopy, have been proposed to expand screening programs.Screening for Barrett's esophagusMatt Atkinson, Amitabh Chak10.1016/j.tgie.2010.02.009Techniques in Gastrointestinal Endoscopy 12, 2 (2010)2010-04-01Techniques in Gastrointestinal Endoscopy2010-04-01122S1096-2883(10)X0003-16266http://www.techgiendoscopy.com/article/PIIS109628831000015X/abstract?rss=yesSurveillance in the context of Barrett's esophagus (BE) implies follow-up endoscopy and biopsy of a patient with established BE. Therefore, we must have a clinical definition of BE, have criteria for which patients with BE should be surveyed, define the intervals of surveillance, and prescribe the biopsy protocol. There are no randomized trials of surveillance in BE, so evidence-based experts say not to survey. Whatever the documented value of surveillance, we need to identify the issues in the clinical context. The availability of effective, cost-effective, and safe ablation techniques for Barrett's neoplasia (dysplasia and early adenocarcinoma) provides an impetus to identify these neoplastic lesions to apply treatments to reduce the progression to cancer. The identification of treatable neoplasia provides the pragmatic rational for surveillance.Surveillance of Barrett's esophagusRichard E. Sampliner10.1016/j.tgie.2010.02.004Techniques in Gastrointestinal Endoscopy 12, 2 (2010)2010-04-01Techniques in Gastrointestinal Endoscopy2010-04-01122S1096-2883(10)X0003-16768http://www.techgiendoscopy.com/article/PIIS1096288310000197/abstract?rss=yesBarrett's esophagus (BE) is the replacement of the normal squamous lining of the distal esophagus by columnar mucosa. It is the recognized precursor of esophageal adenocarcinoma, with tumors arising through an inflammation–metaplasia–dysplasia–carcinoma sequence. Effective communication between the gastroenterologist and pathologist is crucial to the diagnosis, risk assessment, and management of BE. This review will focus on the histopathologic aspects of BE especially relevant to the practicing gastroenterologist, including discussion of normal anatomy and histology of the distal esophagus and gastroesophageal junction, varying definitions of BE used around the world, histology of nondysplastic BE, significance of goblet cells, grading of Barrett neoplasia, natural history of BE, biomarkers of progression, and pathology of postablation BE and endoscopic mucosal resection.Histopathology of Barrett's esophagus: A review for the practicing gastroenterologistAndrew M. Bellizzi, Robert D. Odze10.1016/j.tgie.2010.02.008Techniques in Gastrointestinal Endoscopy 12, 2 (2010)2010-04-01Techniques in Gastrointestinal Endoscopy2010-04-01122S1096-2883(10)X0003-16981http://www.techgiendoscopy.com/article/PIIS1096288310000112/abstract?rss=yesThe goal of surveillance in Barrett's esophagus is the detection and treatment of early neoplasia. It has been shown that patients with early lesions (intraepithelial neoplasia or intramucosal cancer) can be cured with a high success rate. This is in contrast to advanced esophageal adenocarcinoma, which has a poor prognosis. Currently, many authorities regard endoscopic treatment for early neoplasia as equivalent, if not superior, to radical surgery because the cure rates are comparable with less mortality and morbidity. With the rising popularity of, and the expanding experience with, endoscopic treatment, principally endoscopic resection, precise localization of the neoplastic lesions within the Barrett's segment has become important for precise staging and successful resection. This localization results in low rates of residual and recurrent neoplasia. In recent years, many developments in the field of endoscopic imaging and treatment of Barrett's esophagus have greatly advanced the field. When it comes to endoscopic detection of early neoplastic lesions in Barrett's esophagus, the 21st century has brought several paradigm shifts.Advanced endoscopic imaging in Barrett's esophagusMohammed A. Kara, Wouter Curvers, Jacques Bergman10.1016/j.tgie.2010.01.010Techniques in Gastrointestinal Endoscopy 12, 2 (2010)2010-04-01Techniques in Gastrointestinal Endoscopy2010-04-01122S1096-2883(10)X0003-18289http://www.techgiendoscopy.com/article/PIIS1096288310000288/abstract?rss=yesConfocal laser endomicroscopy (CLE) is a novel technique that allows in vivo microscopic imaging of the gastrointestinal mucosa. CLE has been used to study many gastrointestinal disorders, including Barrett's esophagus (BE), gastrointestinal neoplasia, and inflammatory bowel disease. There are two endomicroscopy systems currently used, an endoscope-based system (eCLE) and a probe-based system (pCLE), each with different strengths and weaknesess. This article discusses the current technique for performing endomicroscopy as it is applied for evaluation of patients with BE and compares the two available systems. Learning endomicroscopy requires technical mastery to obtain stable images and cognitive mastery of endomicroscopy image interpretation.Confocal endomicroscopyKerry B. Dunbar, Marcia I. Canto10.1016/j.tgie.2010.02.010Techniques in Gastrointestinal Endoscopy 12, 2 (2010)2010-04-01Techniques in Gastrointestinal Endoscopy2010-04-01122S1096-2883(10)X0003-19099http://www.techgiendoscopy.com/article/PIIS1096288310000161/abstract?rss=yesBarrett's esophagus, a metaplastic change in the esophagus wherein normal squamous epithelium is replaced by specialized columnar epithelium, is a complication of chronic gastroesophageal reflux disease. There is an association between Barrett's esophagus and esophageal adenocarcinoma. Since 1977, esophageal cancer has increased by more than 500% in the United States. The optimal treatment for dysplastic Barrett's esophagus is unclear. One method for treating dysplastic Barrett's esophagus is radiofrequency ablation (RFA). RFA has been shown to effectively induce reversion to neosquamous tissue, and has been demonstrated in a randomized trial to significantly decrease the risk of progression of dysplasia to cancer. Minimal complications have been reported, and the technique can be performed in an outpatient setting. The aim of this article is to outline and discuss the technical aspects of performance of RFA. The basic principles of RFA and the rationale for adapting this technique to the esophagus will be briefly discussed. Next, the equipment and technique will be explained in detail, including suggestions for improved outcomes. Finally, potential complications, follow-up intervals, and expected outcomes will be addressed.Radiofrequency ablation of Barrett's esophagusDavid J. Frantz, Evan S. Dellon, Nicholas J. Shaheen10.1016/j.tgie.2010.02.005Techniques in Gastrointestinal Endoscopy 12, 2 (2010)2010-04-01Techniques in Gastrointestinal Endoscopy2010-04-01122S1096-2883(10)X0003-1100107http://www.techgiendoscopy.com/article/PIIS109628831000032X/abstract?rss=yesEndoscopic Mucosal Resection is a well established diagnostic and therapeutic technique in the management of esophageal neoplasia arising in the background of Barrett's esophagus. It is a valuable adjunct to ablative techniques for the treatment of dysplasia Barrett's esophagus. This article reviews the rationale, indications, methods and outcomes of endoscopic mucosal resection in Barrett's esophagus.Endoscopic mucosal resectionGanapathy A. Prasad, Vikneswaran Namasivayam10.1016/j.tgie.2010.03.001Techniques in Gastrointestinal Endoscopy 12, 2 (2010)2010-04-01Techniques in Gastrointestinal Endoscopy2010-04-01122S1096-2883(10)X0003-1108115http://www.techgiendoscopy.com/article/PIIS1096288310000173/abstract?rss=yesBiomarkers are substances that can be used to indicate normal or diseased states. In clinical settings, the term biomarker generally refers to a molecular marker produced by tissues whose detection heralds a diseased state. For patients with Barrett's esophagus, there are at least 3 clinical settings in which the use of molecular biomarkers has been proposed, including (1) stratifying the risk of neoplastic progression, (2) serving as an adjunct to aid in the diagnosis of dysplasia, and (3) predicting response to ablative therapies. Although the routine clinical use of biomarkers in any of these clinical settings is not yet recommended, it seems reasonable to assume that biomarker validation studies will be carried out in the coming years and that movement into the clinics will be inevitable. This article reviews the current progress in using biomarkers in each of the clinical settings described earlier with a focus on the molecular biomarkers, which have advanced the farthest toward use in routine clinical practice.Biomarkers in Barrett's esophagusRhonda F. Souza10.1016/j.tgie.2010.02.006Techniques in Gastrointestinal Endoscopy 12, 2 (2010)2010-04-01Techniques in Gastrointestinal Endoscopy2010-04-01122S1096-2883(10)X0003-1116121