{
  "abstract": "Barrett’s oesophagus is a precancerous condition defined as an area of columnar-lined mucosa (>1 cm) in the oesophagus and confirmed by the presence of intestinal metaplasia on histology. Recent data from the UK highlight that neoplasia is frequently missed during gastroscopy in patients with Barrett’s oesophagus (Post-Endoscopy Upper Gastrointestinal Cancers or PEUGIC rate 21% in Barrett’s vs 6.2% for all upper gastrointestinal cancer).1 This calls for improvement in the assessment and detection of Barrett’s neoplasia during endoscopic examinations. The endoscopic assessment primarily involves identification of important landmarks to quantify the extent of Barrett’s oesophagus. This is followed by a detailed assessment of Barrett’s mucosa using white light, blue light (image enhancements: narrow band imaging or NBI, blue light imaging or BLI, i-scan) and/or acetic acid to identify a neoplastic focus (video 1, audio transcript available as supplementary materials). Targeted biopsies are then taken of any suspicious lesion and the mapping is completed with quadrantic random biopsies every 2 cm for non-dysplastic Barrett’s. This video illustrates all the above steps using a series of case examples. In brief, Barrett’s is quantified using Prague classification which involves identifying the top of gastric fold (TGF) and then measuring the length of circumferential involvement (C) and the maximum length from TGF to the squamocolumnar junction (M). This is followed by careful evaluation of Barrett’s, spending an average of 1 min/cm of Barrett’s length. White light evaluation is important to identify any subtle abnormalities which are then carefully inspected. Blue Light Imaging for Barrett's Neoplasia Classification or BLINC for BLI and the classification created by the Barrett's international NBI group or BING for NBI are validated classifications which can help in detection of Barrett’s neoplasia (figure 1). The BLINC classification has three broad domains: focal darkness, pits and vessels (type, density and distribution).2 The BING classification for NBI includes the evaluation of the mucosal (tubular, circular or irregular pattern) and vascular pattern (regular and irregular) (figure 1).3 BLI and NBI use blue light waves and, even if it has not been demonstrated, it is likely that BLINC and BING can be used for both technologies.",
  "authors": [
    {
      "affiliations": [
        "Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK"
      ],
      "name": "Elisabetta Mastrorocco"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK"
      ],
      "name": "Hein Myat Thu Htet"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK"
      ],
      "name": "Pradeep Bhandari"
    }
  ],
  "title": "Improving the quality of Barrett’s endoscopy",
  "uid": "84ce4858-6f13-5298-89a1-925b0f9a7e13"
}