The utility of a novel narrow band imaging endoscopy system in patients with Barrett's esophagus.
BACKGROUND
A narrow band imaging (NBI) endoscopy system has been developed that allows superficial surface imaging of esophageal tissue in vivo.


OBJECTIVE
The objective was to assess the potential of NBI for prediction of histology during screening and surveillance endoscopy in patients with Barrett's esophagus (BE).


METHODS
A prospective cohort study.


METHODS
Veterans Affairs Medical Center.


METHODS
Fifty-one patients with known or suspected BE.


METHODS
NBI images were graded according to mucosal pattern (ridge/villous, circular and irregular/distorted) and vascular pattern (normal and abnormal), and correlated with histology in a prospective, blinded manner.


METHODS
Biopsy-confirmed intestinal metaplasia (IM) and dysplasia were used as the outcome measures.


RESULTS
Of 51 patients (mean BE length 3.5 cm), 28 had IM without dysplasia, 8 had low-grade dysplasia (LGD), 7 had high-grade dysplasia (HGD), and 8 had cardiac-type mucosa. The sensitivity, specificity, and positive predictive value of ridge/villous pattern for diagnosis of IM without HGD were 93.5%, 86.7%, and 94.7%, respectively. The sensitivity, specificity, and positive predictive value of irregular/distorted pattern for HGD were 100%, 98.7%, and 95.3%, respectively. If biopsies were limited to areas with irregular/distorted pattern, no patient with HGD would have been missed. However, NBI was unable to distinguish areas of IM from those with LGD.


CONCLUSIONS
The open study design without a control group was the main limitation.


CONCLUSIONS
NBI is a novel diagnostic tool with a high degree of accuracy for the detection of metaplastic and dysplastic tissue within the BE segment.
Sharma
Prateek
P
Division of Gastroenterology and Hepatology, Department of Pathology, and Kansas Cancer Institute, University of Kansas School of Medicine and Veterans Affairs Medical Center, Kansas City, Missouri 64128-2295, USA.
Bansal
Ajay
A
Mathur
Sharad
S
Wani
Sachin
S
Cherian
Rachel
R
McGregor
Douglas
D
Higbee
April
A
Hall
Sandra
S
Weston
Allan
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004947:Esophagus / Q000098:blood supply / Q000473:pathology*; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000098:blood supply / Q000473:pathology; D011446:Prospective Studies; D012680:Sensitivity and Specificity