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Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett's oesophagus: a prospective, international, randomised controlled trial
  1. Prateek Sharma1,2,
  2. Robert H Hawes3,
  3. Ajay Bansal1,2,
  4. Neil Gupta1,2,
  5. Wouter Curvers4,
  6. Amit Rastogi1,2,
  7. Mandeep Singh1,2,
  8. Matt Hall5,
  9. Sharad C Mathur6,7,
  10. Sachin B Wani1,2,
  11. Brenda Hoffman3,
  12. Srinivas Gaddam1,
  13. Paul Fockens4,
  14. Jacques J Bergman4
  1. 1Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri, USA
  2. 2Division of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Missouri, USA
  3. 3Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA
  4. 4Division of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands
  5. 5Child Health Corporation of America, Shawnee Mission, Kansas, Missouri, USA
  6. 6Department of Pathology and Laboratory Medicine, Veterans Affairs Medical Center, Kansas City, Missouri, USA
  7. 7Department of Pathology and Laboratory Medicine, University of Kansas School of Medicine, Kansas City, Missouri, USA
  1. Correspondence to Professor Prateek Sharma, Division of Gastroenterology, Department of Veterans Affairs Medical Center, 4801 E Linwood Blvd, Kansas City, MO 64128, USA; psharma{at}kumc.edu

Abstract

Background White light endoscopy with random biopsies is the standard for detection of intestinal metaplasia (IM) and neoplasia in patients with Barrett's oesophagus (BO). Narrow band imaging (NBI) highlights surface patterns that correlate with IM and neoplasia in BO.

Objective To compare high-definition white light (HD-WLE) and NBI for detection of IM and neoplasia in BO.

Design International, randomised, crossover trial comparing HD-WLE and NBI. Patients referred for BO screening/surveillance at three tertiary referral centres were prospectively enrolled and randomised to HD-WLE or NBI followed by other procedures in 3–8 weeks. During HD-WLE, four quadrant biopsies every 2 cm, together with targeted biopsies of visible lesions (Seattle protocol), were obtained. During NBI examination, mucosal and vascular patterns were noted and targeted biopsies were obtained. All biopsies were read by a single expert gastrointestinal pathologist in a blinded fashion.

Results 123 patients with BO (mean age 61; 93% male; 97% Caucasian) with mean circumferential and maximal extents of 1.8 and 3.6 cm, respectively, were enrolled. Both HD-WLE and NBI detected 104/113 (92%) patients with IM, but NBI required fewer biopsies per patient (3.6 vs 7.6, p<0.0001). NBI detected a higher proportion of areas with dysplasia (30% vs 21%, p=0.01). During examination with NBI, all areas of high-grade dysplasia and cancer had an irregular mucosal or vascular pattern.

Conclusions NBI targeted biopsies can have the same IM detection rate as an HD-WLE examination with the Seattle protocol while requiring fewer biopsies. In addition, NBI targeted biopsies can detect more areas with dysplasia. Regular appearing NBI surface patterns did not harbour high-grade dysplasia/cancer, suggesting that biopsies could be avoided in these areas.

  • Narrow band imaging
  • Barrett's esophagus
  • esophageal neoplasm
  • esophagoscopy
  • image enhancement
  • gastroesophageal reflux disease
  • low-grade dysplasia
  • Barrett's carcinoma
  • adenocarcinoma
  • Barrett's oesophagus
  • endoscopy
  • cost-effectiveness
  • decision analysis
  • colorectal cancer screening

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Footnotes

  • Results of this study presented in part at as an oral presentation at Digestive Diseases Week 2009, Chicago, Illinois, USA.

  • Funding This study was funded through an ASGE research award and an investigator initiated grant from Olympus America. The study sponsor had no role in study design, data collection, analysis or interpretation.

  • Competing interests PS has received previous grants/research support from Olympus America Inc, BARRX Medical Inc and Takeda Pharmaceutical Company Ltd. RHH serves as a consultant for Olympus America. PF serves as a consultant for Boston Scientific and Torax Medical. He has received grant/research support from Olympus Medical Systems and royalties from Elsevier. AR has received previous grant/research support from Olympus America. JJB has received previous grant/research support from BARRX Medical, Cook Medical, Olympus and Astra Zeneca. All other authors have no conflicts of interest to declare.

  • Ethics approval Ethics approval was provided by three local institutional review boards.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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