Endoscopic video-autofluorescence imaging followed by narrow band imaging for detecting early neoplasia in Barrett's esophagus.
BACKGROUND
Video-autofluorescence imaging (AFI) and narrow band imaging (NBI) are new endoscopic techniques that may improve the detection of high-grade intraepithelial neoplasia (HGIN) in Barrett's esophagus (BE). AFI improves the detection of lesions but may give false-positive findings. NBI allows for detailed inspection of the mucosal and (micro)vascular patterns, which are related to HGIN.


OBJECTIVE
A proof-of-principle study to combine AFI and NBI to improve the detection of HGIN and to reduce false-positive findings.


METHODS
Cross-sectional study of consecutive eligible patients.


METHODS
Single-center.


METHODS
Twenty patients with BE with suspected or endoscopically treated HGIN were investigated with 2 prototype imaging systems: AFI (inspection with high-resolution videoendoscopy and autofluorescence imaging for detection of lesions) and NBI (for detailed inspection of mucosal and vascular patterns of identified lesions). Lesions were sampled for histopathologic evaluation.


METHODS
The positive predictive value of AFI alone and of AFI-NBI for detecting HGIN and the reduction of false-positive findings because of the use of NBI.


RESULTS
All of the 28 lesions with HGIN were identified with AFI. Seventeen were identified with white light (61%). Forty-seven suspicious lesions were detected with AFI: 28 contained HGIN (60%) and 19 were false positive (40%). With NBI, 25 of the true-positive lesions had definitely suspicious patterns, and 3 had dubiously suspicious patterns. Of the 19 false positives, 14 were not suspicious on NBI. The false-positive rate, therefore, was reduced from 40% to 10%. Low-grade dysplasia was found in 4 of the remaining 5 false positives. All of the 14 patients with HGIN were identified by AFI-NBI (sensitivity 100%).


CONCLUSIONS
Uncontrolled study in high-risk patients.


CONCLUSIONS
This proof-of-principle study confirms that AFI can be used as a red-flag technique to detect suspicious lesions. With NBI, detailed inspection of the surface patterns can be performed. This combination may increase the accuracy of detecting HGIN in BE.
Kara
Mohammed A
MA
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.
Peters
Femke P
FP
Fockens
Paul
P
ten Kate
Fiebo J W
FJ
Bergman
Jacques J G H M
JJ
D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology*; D002278:Carcinoma in Situ / Q000473:pathology; D003430:Cross-Sectional Studies; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004938:Esophageal Neoplasms / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D005453:Fluorescence; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology*; D014741:Video Recording