medicine: midazolam+fentanyl (most common)
patient with a lot of pain medication, use propofol for deeper sedation
Barrette esophagus:
A, Lower esophageal sphincter and squamocolumnar junction; B, endoscopic view.
A, Normal esophageal epithelium; B-D, variants of Barrett’s esophagus.
Histology of Barrett’s esophagus; A, no dysplasia, B, low-grade dysplasia, and C, high- grade dysplasia.
base on visual change under endoscopy+pathologic diagnosis, if see visual change but pathology not supporting, it is not barrette esophagus.
Barrett's esophagus is the condition in which any extent of metaplastic columnar epithelium that predisposes to cancer development replaces the stratified squamous epithelium that normally lines the distal esophagus.
The condition develops as a consequence of chronic gastroesophageal reflux disease (GERD), and predisposes to the development of adenocarcinoma of the esophagus.
EPIDEMIOLOGY — Barrett's esophagus is usually discovered during endoscopic examinations of middle-aged and older adults whose mean age at the time of diagnosis is approximately 55 years
Barrett's esophagus appears to be uncommon in blacks and Asians.
Obesity is a risk factor for gastroesophageal reflux disease (GERD) and may be a risk factor for Barrett's esophagus
44 percent of patients lacked "troublesome heartburn and/or acid regurgitation during the past three months" suggesting that screening programs based upon reflux symptoms alone may be inadequate to identify patients with Barrett's esophagus.
Familial aggregation of Barrett's esophagus has been described. It is unclear if this is due to common environmental exposures and/or an inherited predisposition. Germline mutations in the MSR1, ASCC1, and CTHRC1 genes have been associated with the presence of Barrett's esophagus and esophageal adenocarcinoma. However, large cohort studies are needed to validate these findings.
CLINICAL FEATURES: symptoms of associated gastroesophageal reflux disease (GERD), such as heartburn, regurgitation, and dysphagia.
DIAGNOSTIC CRITERIA — Endoscopic examination generally is required to diagnose Barrett's esophagus.
Two criteria must be fulfilled:
■The endoscopist must document that columnar epithelium lines the distal esophagus.
■Histologic examination of biopsy specimens from that columnar epithelium must reveal intestinal metaplasia. Some data suggest that gastric cardiac-type epithelium in the esophagus also might predispose to cancer and thus might be considered "Barrett's esophagus," but most authorities still require the presence of intestinal metaplasia for an unequivocal diagnosis
SUMMARY AND RECOMMENDATIONS
■Barrett's esophagus is usually discovered during endoscopic examinations of middle-aged and older adults whose mean age at the time of diagnosis is approximately 55 years. The specialized intestinal columnar metaplasia typical of Barrett's esophagus causes no symptoms. Most patients are seen initially for symptoms of associated gastroesophageal reflux disease (GERD), such as heartburn, regurgitation, and dysphagia. (See 'Epidemiology' above.)
■Two criteria must be fulfilled to make a diagnosis of Barrett's esophagus: (See 'Diagnostic criteria' above.) •The endoscopist must document that columnar epithelium lines the distal esophagus. •Histologic examination of biopsy specimens from that columnar epithelium must reveal specialized intestinal metaplasia. Some data suggest that gastric cardiac-type epithelium in the esophagus also might predispose to cancer and thus might be considered "Barrett's esophagus," but most authorities still require the presence of specialized intestinal metaplasia for an unequivocal diagnosis.
■It has been proposed that patients with GERD symptoms should be screened endoscopically for Barrett's esophagus. We suggest that patients with multiple risk factors for esophageal adenocarcinoma undergo screening for Barrett's esophagus. However, the evidence supporting this recommendation is weak, and we feel that decisions on when to recommend endoscopic screening should be individualized. Factors known to increase the risk for Barrett's esophagus include white ethnicity, older age, obesity (especially central obesity), and long duration of GERD symptoms.
some info and pics are from
https://gi.jhsps.org/GDL_DiseaseLibrary.aspx?CurrentUDV=31
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