title: Endoscopic trimodal imaging versus standard video endoscopy for detection of early Barrett's neoplasia: a multicenter, randomized, crossover study in general practice.
abstract: BACKGROUND
  Endoscopic trimodal imaging (ETMI) may improve detection of early neoplasia in Barrett's esophagus (BE). Studies with ETMI so far have been performed in tertiary referral settings only.
  
  
  OBJECTIVE
  To compare ETMI with standard video endoscopy (SVE) for the detection of neoplasia in BE patients with an intermediate-risk profile.
  
  
  METHODS
  Multicenter, randomized, crossover study.
  
  
  METHODS
  Community practice.
  
  
  METHODS
  BE patients with confirmed low-grade intraepithelial neoplasia (LGIN) underwent both ETMI and SVE in random order (interval 6-16 weeks). During ETMI, BE was inspected with high-resolution endoscopy followed by autofluorescence imaging (AFI). All visible lesions were then inspected with narrow-band imaging. During ETMI and SVE, visible lesions were sampled followed by 4-quadrant random biopsies every 2 cm.
  
  
  METHODS
  Overall histological yield of ETMI and SVE and targeted histological yield of ETMI and SVE.
  
  
  RESULTS
  A total of 99 patients (79 men, 63±10 years) underwent both procedures. ETMI had a significantly higher targeted histological yield because of additional detection of 22 lesions with LGIN/high-grade intraepithelial neoplasia (HGIN)/carcinoma (Ca) by AFI. There was no significant difference in the overall histological yield (targeted+random) between ETMI and SVE. HGIN/Ca was diagnosed only by random biopsies in 6 of 24 patients and 7 of 24 patients, with ETMI and SVE, respectively.
  
  
  CONCLUSIONS
  Inspection, with high-resolution endoscopy and AFI, was performed sequentially.
  
  
  CONCLUSIONS
  ETMI performed in a community-based setting did not improve the overall detection of dysplasia compared with SVE. The diagnosis of dysplasia is still being made in a significant number of patients by random biopsies. Patients with a confirmed diagnosis of LGIN have a significant risk of HGIN/Ca. (
  
  
  BACKGROUND
  ISRCTN91816824; NTR867.).
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands. w.l.curvers@amc.uva.nl
authors.forename: Wouter L
authors.initials: WL
authors.lastname: Curvers
authors.forename: Frederike G
authors.initials: FG
authors.lastname: van Vilsteren
authors.forename: Lubertus C
authors.initials: LC
authors.lastname: Baak
authors.forename: Clarisse
authors.initials: C
authors.lastname: Böhmer
authors.forename: Rosalie C
authors.initials: RC
authors.lastname: Mallant-Hent
authors.forename: Anton H
authors.initials: AH
authors.lastname: Naber
authors.forename: Arnout
authors.initials: A
authors.lastname: van Oijen
authors.forename: Cyriel Y
authors.initials: CY
authors.lastname: Ponsioen
authors.forename: Pieter
authors.initials: P
authors.lastname: Scholten
authors.forename: Ed
authors.initials: E
authors.lastname: Schenk
authors.forename: Erik
authors.initials: E
authors.lastname: Schoon
authors.forename: Cees A
authors.initials: CA
authors.lastname: Seldenrijk
authors.forename: Gerrit A
authors.initials: GA
authors.lastname: Meijer
authors.forename: Fiebo J
authors.initials: FJ
authors.lastname: ten Kate
authors.forename: Jacques J
authors.initials: JJ
authors.lastname: Bergman
mesh_terms: D001471:Barrett Esophagus / Q000175:diagnosis*; D018592:Cross-Over Studies; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D058006:General Practice / Q000379:methods*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014741:Video Recording