Esophagus
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Squamous dysplasia of the oesophagus
Early squamous neoplasia is a very aggressive pathology and the decision when to choose oesophageal sparing local endoscopic resective therapy, over invasive interventions such as surgery, depends on accurate staging. Micro-vasculature in squamous dysplasia is key to informing the endoscopist on the potential depth of invasion. Intrapapillary capillary loops arise from the submucosal veins. This short video clip shows an abnormal area with squamous dysplasia that with the magniview scope and i-scan 2 has type II IPCSLs. The normal vasculature is shown before the abnormal vessels come in to view with zoom imaging. This area was resected by EMR and show M3 invasion alone.
Courtesy of Dr. Rehan Haidry, UCLH, UK
Squamous cell cancer of the oesophagus
Early squamous cell cancer of the oesophagus is easily missed. In these flat lesions, it is also difficult to identify the margins of the tumor. In this patient i-scan was used to assess the extension of the mucosal cancer before performing endoscopic submucosal dissection.
Courtesy of Dr. Michael Häfner St. Elisabeth Krakenhaus, Austria
Early squamous neoplasia of the oesophagus (sq emr)
Early squamous neoplasia of the oesophagus is often very difficult to appreciate with white light endoscopy alone. This patient was referred for assessment of acid reflux symptoms and the referring centre had taken random oesophageal biopsies which reported features consistent with atypia. With enhanced imaging and i-scan, there is an extensive circumferential lesion with abnormal vasculature and mucosal irregularity. With lugol’s chromoendoscopy the extent of the lesion is further appreciated with extensive areas of oesophageal unstaining.
Courtesy of Dr. Rehan Haidry, UCLH, UK
A rare case of malignant melanoma of the oesophagus (Melanoma)
The clip shows a very interesting appearance of the oesophagus. With the various enhancement settings and i-scan, one can see multiple pigmented plaques throughout the tubular oesophagus with areas of hyper-vascularity and dilated tortuous micro-vasculature on i-scan 2. This patient has malignant melanoma of the oesophagus and went on to have an oesophagectomy.
Courtesy of Dr. Rehan Haidry, UCLH, UK
Intramucosal cancer in Barrett`s Oesophagus (Zoom IMC)
This short video shows the exciting new magniview gastroscope in use. This is a patient with a previous Barrett’s Cancer that was resected. At first inspection there appears to be residual flat Barrett’s oeosphagus. However a combination of i-scan and acetic acid shows an area at the right wall with featureless mucosa and abnormal irregular micro-vasculature with zoom endoscopy. One can appreciate the normal adjacent villous mucosa next to the featureless area of intramucosal cancer that was resected by EMR.
Courtesy of Dr. Rehan Haidry, UCLH, UK
Early oesophageal neoplasia arising in a patient with Barrett`s oesophagus (ACA EMR)
This is a recording of a patient with early Barrett’s cancer. They were referred for radiofrequency ablation. With enhanced imaging and i-scan 1 there is a very subtle nodule with an area of irregularity at the centre.
Courtesy of Dr. Rehan Haidry, UCLH, UK
