title: Multiple-Band Imaging Provides Better Value Than White-light Endoscopy in Detection of Dysplasia in Patients With Barrett's Esophagus.
abstract: OBJECTIVE
  Surveillance of patients with Barrett's esophagus usually is performed with standard white-light endoscopy (SDWLE) and the collection of 4 biopsy specimens (every 1-2 cm of the metaplastic segment), based on Seattle protocol. New endoscopic techniques are used routinely, but have been validated based only on low-grade evidence. We aimed to validate the use of high-definition magnifying endoscopy with multiple-band imaging (HDMEMBI) with a targeted biopsy collection for the detection of dysplasia, using SDWLE with quadrant biopsy collection as the reference.
  
  
  METHODS
  In a cross-over study, patients with suspected or histologically verified BE (without known neoplasia) seen at a tertiary referral high-volume endoscopy center in Sweden, from November 2009 through November 2012, were assigned randomly to undergo HDMEMBI (n = 63) or SDWLE (n = 47) as the initial procedure, followed by the other procedure in 1 to 4 months. The primary end point was the total number of subjects found to have low-grade dysplasia or high-grade dysplasia (HGD) by each technique. Secondary end points included the number of biopsy specimens taken and the duration of each procedure.
  
  
  RESULTS
  There was no significant difference between groups in diagnostic yield for low-grade dysplasia (14 in HDMEMBI vs. 13 in SDWLE) or HGD. Four HGDs were found: 3 using HDMEMBI and 1 using SDWLE. Significantly fewer biopsy specimens were collected during the HDMEMBI procedure (P < .001). The diagnostic yield for the detection of dysplasia per biopsy specimen collected therefore was significantly higher for HDMEMBI than SDWLE (0.25 vs. 0.07; P = .018). There was no significant difference in the duration of procedures.
  
  
  CONCLUSIONS
  There is no significant difference in the detection of dysplastic lesions using HDMEMBI with targeted collection of biopsy specimens vs SDWLE with 4-quadrant biopsy specimen collection. However, HDMEMBI requires the collection of significantly fewer biopsy specimens, providing better value for health care providers. ClinicalTrials.gov number: NCT01694511.
authors.affiliation: Department of Gastrosurgical Research, Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address: svein.olav.bratlie@vgregion.se.
authors.forename: Svein Olav
authors.initials: SO
authors.lastname: Bratlie
authors.affiliation: Department of Gastrosurgical Research, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Johnsson
authors.affiliation: Department of Gastrosurgical Research, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Claes
authors.initials: C
authors.lastname: Jönsson
authors.affiliation: Department of Gastrosurgical Research, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Fändriks
authors.affiliation: Department of Gastrosurgical Research, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Edebo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000150:complications*; D001706:Biopsy; D018592:Cross-Over Studies; D004938:Esophageal Neoplasms / Q000175:diagnosis*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008027:Light; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging / Q000379:methods*; D011446:Prospective Studies; D011897:Random Allocation; D013548:Sweden
keywords: BE; Esophageal Adenocarcinoma; Esophageal Cancer; Metaplasia