ENDOSCOPIC

ESOPHAGEAL IMAGES

Ho Dang Quy Dung M.D

Oesophageal Glycogenic Acanthosis
Oesophageal Glycogenic Acanthosis
Tuùi thöøa 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 THÖØA THÖÏC QUAÛN
TUÙI THÖØA THÖÏC QUAÛN
Heïp laønh tính thöïc quaûn
Endoscopic appearance of benign strictures
 Heïp laønh tính thöïc quaûn
Endoscopic appearance of benign strictures
NAÁM THÖÏC QUAÛN
Candida Oesophagitis
NAÁM THÖÏC QUAÛN
Candida Oesophagitis
NAÁM THÖÏC QUAÛN
Candida Oesophagitis
LOEÙT HEÏP THÖÏC QUAÛN DO THUOÁC
Oesophageal Injuries due to Drugs
LOEÙT THÖÏC QUAÛN
Heïp laønh tính thöïc quaûn
Endoscopic appearance of benign strictures
Heïp laønh tính thöïc quaûn
Endoscopic appearance of benign strictures
 Types of dilators:
Hurst/Maloney

Types of dilators (wire-

guided): Savary/
Eder-Puestow
Heïp laønh tính thöïc quaûn
Endoscopic appearance of benign strictures
Types of dilators: balloons TTS
Types of dilators: balloons
Types of dilators: balloons TTS

Before After
Achalasia
Achalasia
Pneumatic balloon dilators for achalasia
 Heller myotomy as
therapy for achalasia
DAÕN TÓNH MAÏCH THÖÏC QUAÛN
Venous layers of the esophagus
Pathogenesis of esophageal varices
Portal venous blood flow seen with
esophageal and gastric varices
SARIN’S CLASSIFICATION
Hernia Hiati
Anatomy of the esophageal hiatus
Types of hiatal hernia
Types of hiatal hernia
 The LA Classification system for the
endoscopic assessment of reflux esophagitis

Grade A Grade B
One (or more)
mucosal break, no
longer than 5 mm,
that does not extend
between the tops of
two mucosal folds
One (or more) mucosal
break, more than 5 mm
long, that does not
extend between the tops of
two mucosal folds

Grade C Grade D
One (or more) One (or more) mucosal break
mucosal break that involves at
that is continuous least 75% of the esophageal
between the tops circumference
of two or more
mucosal folds,
but which involves
less than 75% of the
circumference

Lundell et al 1999
 The LA Classification system
– Grade A reflux esophagitis
Grade A: One (or more) mucosal break, no longer than 5 mm,
that does not extend between the tops of two
mucosal folds.

Stomach
 The LA Classification system
– Grade B reflux esophagitis
Grade B: One (or more) mucosal break, more than 5 mm long, that
does not extend between the tops of two mucosal folds.

Stomach
 The LA Classification system
– Grade C reflux esophagitis
Grade C: One (or more) mucosal break that is continuous between
the tops of two or more mucosal folds, but which involves
less than 75% of the circumference.

Stomach
 The LA Classification system
– Grade D reflux esophagitis
Grade D: One (or more) mucosal break that involves at least
75% of the esophageal circumference.

Stomach
 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 Barrett’s esophagus.

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 Barrett’s esophagus with

junction between esophagus displaced squamocolumnar
and stomach delimited by the junction delimited by the
black outline. 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 3 cm or more into the
distal esophagus it is called “long-segment” Barrett’s esophagus.
When extending less than 3 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 Short segment Barrett’s

esophagus. The S-Q junction is esophagus with two small
not observed as it lies even toungues extending proximally
more proximal. into the distal esophagus.
Barrett’s esophagus with
early premalignant
changes (arrow)
Oesophageal Squamous (Squamocellular)
Papilloma
Early oesophageal squamocellular cancer
Oesophageal Cancer
Oesophageal Cancer