title: Narrow-band imaging and white-light endoscopy with optical magnification in the diagnosis of dysplasia in Barrett's esophagus: results of the Asia-Pacific Barrett's Consortium.
abstract: OBJECTIVE
  The advent and utility of new endoscopic imaging modalities for predicting the histology of Barrett's esophagus (BE) in real time with high accuracy appear promising and could potentially obviate the need to perform random biopsies where guidelines are poorly adhered to. We embarked on evaluating the performance characteristics of white-light endoscopy with magnification (WLE-z), narrow-band imaging with magnification (NBI-z) and a combination of both modalities.
  
  
  METHODS
  This was a prospective online study with 28 endoscopists from 11 countries (Asia-Pacific region) participating as assessors. In total, 35 patients with BE were assessed using 150 slides from WLE-z and NBI-z randomly arranged using a simple classification with corresponding histology. The overall Accuracy (Acc), Sensitivity (Sn), Specificity (Sp), Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of WLE-z, NBI-z and a combination of both were calculated.
  
  
  RESULTS
  The overall Acc for WLE-z and NBI-z images was 87.1 % and 88.7 %, respectively. When images from the two modalities were placed side by side, the Acc increased to 90.3 %. The Sn, Sp, PPV, and NPV of WLE-z were 48 %, 92 %, 45 %, and 93 % while with NBI-z, these improved to 89 %, 89 %, 56 %, and 98 %, respectively. When both imaging modalities were viewed together, they improved further to 93 %, 90 %, 61 %, and 99 %.
  
  
  CONCLUSIONS
  The high NPV (99 %) when both WLE-z and NBI-z were used simultaneously indicates that areas with regular appearance that are diagnosed with confidence can effectively be left alone and not biopsied when performed at a skilled resourced center. This approach could potentially lead to a paradigm shift of how patients with BE are assessed.
authors.affiliation: Lyell McEwin Hospital, Adelaide, Australia ; University of Adelaide, Adelaide, Australia.
authors.forename: Rajvinder
authors.initials: R
authors.lastname: Singh
authors.affiliation: Lyell McEwin Hospital, Adelaide, Australia.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Jayanna
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Jennie
authors.initials: J
authors.lastname: Wong
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Lee Guan
authors.initials: LG
authors.lastname: Lim
authors.affiliation: Division of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Division of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Lv
authors.affiliation: Division of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Liu
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yi-Chia
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Ming-Lun
authors.initials: ML
authors.lastname: Han
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Ping-Huei
authors.initials: PH
authors.lastname: Tseng
authors.affiliation: Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
authors.forename: Vikneswaran
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authors.lastname: Namasivayam
authors.affiliation: Asian Institute of Gastroenterology, Hyderabad, India.
authors.forename: Rupa
authors.initials: R
authors.lastname: Banerjee
authors.affiliation: Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Noriya
authors.initials: N
authors.lastname: Uedo
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Wah Kheong
authors.initials: WK
authors.lastname: Chan
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Shiaw Hooi
authors.initials: SH
authors.lastname: Ho
authors.affiliation: Institute of Endoscopy, Zhongshan Hospital, Shanghai, China.
authors.forename: Shi-Yao
authors.initials: SY
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India.
authors.forename: Shobna
authors.initials: S
authors.lastname: Bhatia
authors.affiliation: Department of Endoscopy, Nagoya University Hospital, Nagoya City, Aichi, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Funasaka
authors.affiliation: Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya City, Aichi, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ando
authors.affiliation: Institute of Digestive Disease, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Justin
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Internal Medicine and Gastroenterology, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
authors.forename: Cosmas
authors.initials: C
authors.lastname: Lesmana
authors.affiliation: Lyell McEwin Hospital, Adelaide, Australia ; University of Adelaide, Adelaide, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Tam
authors.affiliation: Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohshiung, Taiwan.
authors.forename: Wen-Lun
authors.initials: WL
authors.lastname: Wang
authors.affiliation: Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohshiung, Taiwan.
authors.forename: Chi-Yang
authors.initials: CY
authors.lastname: Chang
authors.affiliation: Department of Gastroenterology, Asan Medical Center, Seoul, Korea.
authors.forename: Hwoon-Yong
authors.initials: HY
authors.lastname: Jung
authors.affiliation: Department of Gastroenterology, Asan Medical Center, Seoul, Korea.
authors.forename: Kee Wook
authors.initials: KW
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Padjadjaran University, Bandung, Indonesia.
authors.forename: Muhammad Begawan
authors.initials: MB
authors.lastname: Bestari
authors.affiliation: Department of Gastroenterology, Fukuoka University, Chikushi Hospital, Fukuoka, Japan.
authors.forename: Kenshi
authors.initials: K
authors.lastname: Yao
authors.affiliation: Department of Gastroenterology, RIPAS Hospital, Brunei Darussalam.
authors.forename: Vui Heng
authors.initials: VH
authors.lastname: Chong
authors.affiliation: Division of Gastroenterology and Hepatology, Veterans Affairs Medical Centre and University of Kansas School of Medicine, Kansas City, MO, United States.
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Khek-Yu
authors.initials: KY
authors.lastname: Ho