Masterclass: Advanced GI Endoscopic Imaging (On-Demand) | December 2025-Konda - Mastering a High-quality Examination of the Esophagus and a Barrett’s Segment

Konda - Mastering a High-quality Examination of the Esophagus and a Barrett’s Segment

Pdf Summary

The presentation by Dr. Vani J.A. Konda focuses on mastering a high-quality endoscopic examination of the esophagus, emphasizing Barrett’s Esophagus (BE) and related conditions. Key objectives include understanding evolving screening paradigms for BE, improving lesion detection, risk stratification, and treatment decisions.<br /><br />Initial evaluation involves assessing for hiatal hernia, masses, strictures, reflux esophagitis, eosinophilic esophagitis (EoE), and motor disorders. Dysphagia assessment should consider cause (malignancy, strictures, rings, EoE) and symptom characterization. Diagnosis of EoE uses the EREFS scoring system with recommended biopsies from multiple esophageal levels and after clearing food impaction.<br /><br />The CARS score is introduced for endoscopic assessment of achalasia, evaluating contents, anatomy, resistance, and stasis.<br /><br />A high-quality exam requires a thorough retroflexed view of the esophagogastric junction (EGJ) to assess structures, including the Hill grade (valve integrity) and AFS hiatus grade. The Los Angeles (LA) system grades esophagitis severity.<br /><br />Barrett’s esophagus, a risk factor for esophageal adenocarcinoma, is characterized by salmon-colored mucosa with intestinal metaplasia confirmed histologically. Surveillance involves endoscopy every 3-5 years for non-dysplastic BE. Visible lesions require targeted endoscopic mucosal resection (EMR) for accurate diagnosis and staging, as it outperforms biopsy in assessing neoplasia.<br /><br />Optimizing detection includes high-resolution endoscopes, mucolytics, irrigation, inspection time (1 min/cm Barrett’s segment), tip deflection, and image-enhancement technologies. The Prague classification measures BE length, and the Seattle protocol prescribes systematic biopsies to minimize missed neoplasia.<br /><br />Dr. Konda emphasizes a systematic approach summarized as the "5 L’s": Landmarks (identify and document anatomy), Length (measure Barrett’s extent), Look (inspect carefully using enhanced techniques), Lesions (document suspicious lesions), and biopsy protocol at multiple Levels.<br /><br />In conclusion, meticulous examination with validated grading systems, careful retroflexion, thorough documentation, and adherence to biopsy protocols are critical to detecting early neoplasia and improving outcomes in BE and esophageal pathology.

Keywords

Barrett's Esophagus

Endoscopic Examination

Esophagogastric Junction

Eosinophilic Esophagitis

Achalasia

High-Resolution Endoscopy

Prague Classification

Seattle Biopsy Protocol

Endoscopic Mucosal Resection

Los Angeles Esophagitis Grading