Endoscopic Tri-Modal Imaging for Detection of Early Neoplasia in Barrett’s Oesophagus; A multi-centre feasibility study using high-resolution endoscopy, autofluorescence imaging and narrow band imaging incorporated in one endoscopy system

Wouter Lodewijk Curvers ¹, Rajvinder Singh ², Louis-Michel Wong Kee Song ³, Herbert C Wolfsen ³, Krish Ragunath ², Kenneth Wang ³, Michael B Wallace ³, Paul Fockens ¹ and Jacques JGHM Bergman ^4*

¹ Academic Medical Center, Netherlands
² Queens Medical Centre, University Hospital Nottingham, United Kingdom
³ Mayo Clinic, United States
⁴ Acadmic Medical Center, Netherlands

^* To whom correspondence should be addressed. E-mail: j.j.bergman{at}amc.uva.nl.

Accepted 28 August 2007

Abstract

Objective: To investigate the diagnostic potential of Endoscopic Tri-Modal Imaging and the relative contribution of each imaging modality (i.e. high-resolution endoscopy (HRE), autofluorescence imaging (AFI) and narrow band imaging (NBI)) for the detection of early neoplasia in Barrett’s Oesophagus (BO). Design: Prospective multi-centre study Setting: Tertiary referral centres Patients: 84 BO patients Interventions: The BO was inspected with HRE followed by AFI. All lesions detected with HRE and/or AFI were subsequently detailed inspected by NBI for the presence of abnormal mucosal and/or microvascular patterns. Biopsies were obtained from all suspicious lesions for blinded histopathological assessment followed by random biopsies Main outcome measures 1) Number of patients with early neoplasia diagnosed by HRE and AFI; 2) Number of lesions with early neoplasia detected with HRE and AFI; 3) Reduction of false positive AFI findings after NBI. Results: Per patient analysis: AFI identified all 16 patients with early neoplasia identified with HRE and detected an additional 11 patients with early neoplasia that were not identified with HRE. In 3 patients no abnormalities were seen but random biopsies revealed HGD. After HRE inspection, AFI detected an additional 102 lesions; 19 contained HGD/EC (false-positive rate of AFI after HRE: 81%). Detailed inspection with NBI reduced this false positive rate to 26%. Conclusions: In this international multi-centre study, the addition of AFI to HRE increased the detection of both the number of patients and the number of lesions with early neoplasia in patients with BO. The false-positive rate of AFI was reduced after detailed inspection with NBI.

Keywords: Barrett�s Oesophagus, autofluorescence imaging, high-resolution endoscopy, magnification endoscopy, narrow band imaging.

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