Paris classification III: Superficial Barrett-Related Tumors in the Esophagus
Alexander Meining, Ulm | Thomas Rösch, Hamburg
The Paris classification for superficial tumors, which is presented and discussed in detail in the introductory part should be used in a standardized endoscopic terminology. In the following the schematic representation of this classification: In the following, examples for superficial/early Barrett lesions of the esophagus are shown. Here, flat and sessilelesions are predominant, pedunculated tumors are rare. Sessile tumor with substantial intraluminal growth are often no early cancers any more; the same is the case with exavated lesions of different extent (type IIc or even III). From a clinical standpoint, in stage T1sm1 (= bis 500 µm) endoscopic resection is con sidered curative by some, if the other criteria are low risk (G1/2, L0, V0, R0), but evidence is limited. Generally, many of the superficial/early Barrett lesions, which are often diagnosed on routine random biopsy, require then careful and meticulous endoscopic screening using good sedation, cleaning of the esophagus, modern technology with HD endoscopes and image processing, caps and staining (acetic acid).
Examples Barrett Esophagus Neoplasia 1: Type I sessile/elevated
Histology: surprisingly T1m2, basal R0 after ESD