Identification of predictive factors for early neoplasia in Barrett's esophagus after autofluorescence imaging: a stepwise multicenter structured assessment.
BACKGROUND
Autofluorescence imaging is a novel imaging technique that may improve the detection of early neoplasia in Barrett's esophagus. Autofluorescence imaging is, however, associated with a 40% to 81% false-positive rate.


OBJECTIVE
Our purpose was to identify endoscopic features that may predict the presence of early neoplasia in autofluorescence-positive areas.


METHODS
Descriptive and prospective cohort study.


METHODS
Tertiary referral centers for the detection and treatment of early Barrett's neoplasia.


METHODS
Patients undergoing autofluorescence endoscopy. High-quality images with autofluorescence imaging and white-light endoscopy were obtained with corresponding histologic study. A systematic image evaluation process was performed, including an unblinded orientation phase (10 areas), a blinded derivation phase, and a blinded validation phase by 5 international experts in autofluorescence imaging (80 areas). Subsequently the identified features were validated in a prospective pilot study.


METHODS
Association between endoscopic features and presence of early neoplasia in autofluorescence-positive areas.


RESULTS
Autofluorescence intensity, proximity of gastric folds <1 cm, and different appearance on white-light endoscopy were independently associated with early neoplasia in autofluorescence-positive areas on multivariate analysis. The kappa values for interobserver agreement of these factors were moderate, ranging between 0.49 to 0.56. The association with autofluorescence intensity and different appearance on white-light endoscopy was confirmed in a prospective pilot study.


CONCLUSIONS
Selected set of images from a high-risk population (tertiary referral center).


CONCLUSIONS
We found specific endoscopic features that were associated with early neoplasia in autofluorescence-positive areas. These findings can be used in future prospective studies to improve the accuracy of autofluorescence imaging without performing magnification endoscopy for detailed inspection of suspicious areas.
Curvers
Wouter L
WL
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.
Singh
Rajvinder
R
Wallace
Michael B
MB
Song
Louis-Michel Wong Kee
LM
Ragunath
Krish
K
Wolfsen
Herbert C
HC
ten Kate
Fiebo J
FJ
Fockens
Paul
P
Bergman
Jacques J G H M
JJ
D000368:Aged; D001471:Barrett Esophagus / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D001706:Biopsy; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005453:Fluorescence; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010865:Pilot Projects; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016037:Single-Blind Method; D013997:Time Factors