title: Endoscopic tri-modal imaging is more effective than standard endoscopy in identifying early-stage neoplasia in Barrett's esophagus.
abstract: OBJECTIVE
  Endoscopic tri-modal imaging (ETMI) incorporates high-resolution endoscopy (HRE), autofluorescence imaging (AFI), and narrow band imaging (NBI). A recent uncontrolled study found that ETMI improved the detection of high-grade dysplasia (HGD) and early carcinoma (Ca) in Barrett's esophagus (BE). The aim was to compare ETMI with standard video endoscopy (SVE) for the detection of HGD/Ca with the use of a randomized cross-over design.
  
  
  METHODS
  Patients referred for work-up of inconspicuous HGD/Ca were eligible and underwent both SVE and ETMI in randomized order within an interval of 6-12 weeks. During ETMI, inspection with HRE was followed by AFI. Detected lesions were inspected in detail with NBI and biopsied, followed by random biopsies. During SVE, any visible lesion was biopsied followed by random biopsies.
  
  
  RESULTS
  Eighty-seven patients with BE underwent ETMI and SVE. No significant difference was observed in overall histologic yield between ETMI and SVE. ETMI had a significantly higher targeted yield compared with SVE because of AFI. However, the yield of targeted biopsies of ETMI was significantly inferior to the overall yield of SVE. Detailed inspection with NBI reduced the false-positive rate of HRE + AFI from 71% to 48% but misclassified 17% of HGD/Ca lesions as not suspicious.
  
  
  CONCLUSIONS
  ETMI statistically significant improves the targeted detection of HGD/Ca compared with SVE. Subsequent characterization of lesions with NBI appears to be of limited value. At this stage, ETMI cannot replace random biopsies for detection of lesions or targeted biopsies for characterization of lesions in a high-risk population.
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Wouter L
authors.initials: WL
authors.lastname: Curvers
authors.forename: Lorenza
authors.initials: L
authors.lastname: Alvarez Herrero
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
authors.forename: Louis-Michel
authors.initials: LM
authors.lastname: Wong Kee Song
authors.forename: Krish
authors.initials: K
authors.lastname: Ragunath
authors.forename: Herbert C
authors.initials: HC
authors.lastname: Wolfsen
authors.forename: Ganapathy A
authors.initials: GA
authors.lastname: Prasad
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Wang
authors.forename: Venkataraman
authors.initials: V
authors.lastname: Subramanian
authors.forename: Bas L A M
authors.initials: BL
authors.lastname: Weusten
authors.forename: Fiebo J
authors.initials: FJ
authors.lastname: Ten Kate
authors.forename: Jacques J G H M
authors.initials: JJ
authors.lastname: Bergman
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology*; D001706:Biopsy; D018592:Cross-Over Studies; D016145:Endoscopy, Digestive System / Q000379:methods*; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000473:pathology