Gastroenterology

Gastroenterology

Volume 139, Issue 4, October 2010, Pages 1106-1114.e1
Gastroenterology

Imaging and Advanced Technology
Endoscopic Tri-Modal Imaging Is More Effective Than Standard Endoscopy in Identifying Early-Stage Neoplasia in Barrett's Esophagus

https://doi.org/10.1053/j.gastro.2010.06.045Get rights and content

Background & Aims

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.

Section snippets

Setting

This multicenter randomized cross-over study was performed in 5 centers with a tertiary referral function for the detection and treatment of patients with early BE neoplasia: Academic Medical Center, Amsterdam, Netherlands; St Antonius Hospital, Nieuwegein, Netherlands; Mayo Clinic, Jacksonville, Florida; Mayo Clinic, Rochester, Minnesota; and Queens Medical Center, Nottingham, United Kingdom. The study was approved by the institutional review boards of all participating centers

Patients

Between January 2007 and September 2009, 111 eligible patients (age mean ± SD age, 68.0 ± 9.0 yeas; 92 males [83%]; median circumferential Barrett's extent, 4.0 cm [IQR. 2.0–8.0]; median maximal Barrett's extent, 7.0 cm [IQR, 4.0–9.0]) were included in the participating centers. Twenty-four patients were excluded after the first procedure (Supplementary Figure 1): 17 patients exhibited a type 0–I or type 0–III lesion that did not allow a delay in intervention, 4 patients had Barrett's length

Discussion

This is the first randomized cross-over study to compare ETMI with SVE in patients referred for endoscopic evaluation of early BE neoplasia. The randomized cross-over design ensured that each patient acted as his or her own control, allowing pairwise comparison of the 2 techniques investigated. Although expensive and labor intensive, this is considered the optimal method for endoscopic imaging studies. The study was performed in 5 centers with a tertiary referral function for early Barrett's

References (24)

  • W.L. Curvers et al.

    Multimodality imaging in Barrett's esophagus: looking longer, seeing better, and recognizing more

    Gastroenterology

    (2008)
  • S.J. Spechler

    Clinical practiceBarrett's esophagus

    N Engl J Med

    (2002)
  • Cited by (0)

    Conflicts of interest The authors disclose the following: Louis-Michel Wong Kee Song has received research support from Olympus and Fujinon. Krish Ragunath has received research support, educational grants, and speaker honorarium from Olympus-Keymed, United Kingdom. Ganapathy Prasad has received funding from Takeda Pharmaceuticals, NIH/NCI, and the American College of Gastroenterology. Wouter Curvers, Lorenza Alvarez Herrero, Michael B. Wallace, Herbert Wolfsen, Kenneth Wang, Venkataraman Subramanian, Bas Weusten, Fiebo ten Kate, and Jacques Bergman have no conflict of interest to disclose.

    Funding This study was supported by an unrestricted research grant from Olympus Inc, Tokyo, Japan.

    The work of Wouter Curvers and Lorenza Alvarez Herrero is supported by an unrestricted research grant from Astra-Zeneca Netherlands.

    This trial was registered at www.trialregister.nl as ISRCTN 68328077; NTR945.

    View full text