Digestive Endoscopy| Volume 48, ISSUE 9, P1048-1053, September 2016

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A preliminary feasibility study: Narrow-band imaging targeted versus standard white light endoscopy non-targeted biopsies in a surveillance Barrett's population



      Narrow band imaging (NBI) is used in the detection of intestinal metaplasia (IM) and dysplasia in patients with Barrett's oesophagus (BE).


      The study compared the usefulness of NBI with white-light standard endoscopy (WLSE) for the detection of dysplasia and IM in BE and determined the prediction of the histological diagnosis according to the mucosal and vascular patterns obtained by NBI.

      Patients and methods

      A total of 84 patients were prospectively enrolled in the study. Every patient underwent a WLSE with random biopsies and after 4–6 weeks, a NBI examination was performed.


      NBI detected significant more IM positive biopsies than WLSE (74.5% vs. 35.9%; p < 0.0001) and significant more patients with low grade dysplasia (LGD) (7.1% vs. 0%; p = 0.03). Taking biopsy samples from the villous pattern determined the diagnosis of IM (80%) and biopsies from the area covered by the irregular pattern lead to the identification of LGD in 45.4% of the cases and indefinite dysplasia (ID) in 18.2% of the cases.


      A thorough analysis of NBI patterns may lead to real-time IM diagnosis in the absence of the histological examination and may require targeted biopsies from the areas with an irregular pattern for diagnosing dysplasia.


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        • Corley D.A.
        • Mehtani K.
        • Quesenberry C.
        • et al.
        Impact of endoscopic surveillance on mortality from Barrett's esophagus-associated esophageal adenocarcinomas.
        Gastroenterology. 2013; 145: 312-319
        • Chai N.L.
        • Ling-Hu E.Q.
        • Morita Y.
        • et al.
        Magnifying endoscopy in upper gastroenterology for assessing lesions before completing endoscopic removal.
        World Journal of Gastroenterology. 2012; 18: 1295-1307
        • Sharma P.
        • Bansal A.
        • Mathur S.
        • et al.
        The utility of a novel narrow band imaging endoscopy system in patients with Barrett's esophagus.
        Gastrointestinal Endoscopy. 2006; 64: 167-175
        • Spechler S.J.
        • Sharma P.
        • Souza R.F.
        • et al.
        American Gastroenterological Association medical position statement on the management of Barrett's esophagus.
        Gastroenterology. 2011; 140: 1084-1091
        • Wang K.K.
        • Sampliner R.E.
        Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus.
        American Journal of Gastroenterology. 2008; 103: 788-797
        • Abrams J.A.
        • Kapel R.C.
        • Lindberg G.M.
        • et al.
        Adherence to biopsy guidelines for Barrett's esophagus surveillance in the community setting in the United States.
        Clinical Gastroenterology and Hepatology. 2009; 7: 736-742
        • Song J.
        • Zhang J.
        • Wang J.
        • et al.
        Meta-analysis of the effects of endoscopy with narrow band imaging in detecting dysplasia in Barrett's esophagus.
        Diseases of the Esophagus. 2015; 28: 560-566
        • Sharma P.
        • Hawes R.H.
        • Bansal A.
        • et al.
        Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett's oesophagus. A prospective, international, randomized controlled trial.
        Gut. 2013; 62: 15-21
        • Wolfsen H.C.
        • Crook J.E.
        • Krishna M.
        • et al.
        Prospective, controlled tandem endoscopy study of narrow band imaging for dysplasia detection in Barrett's esophagus.
        Gastroenterology. 2008; 135: 24-31
        • Kerkhof M.
        • Van Dekken H.
        • Steyerberg E.W.
        • et al.
        Grading of dysplasia in Barrett's oesophagus: substantial interobserver variation between general and gastrointestinal pathologists.
        Histopathology. 2007; 50: 920-927
        • Kaye P.V.
        • Haider S.A.
        • Ilyas M.
        • et al.
        Barrett's dysplasia and the Vienna classification: reproducibility, prediction of progression and impact of consensus reporting and p53 immunohistochemistry.
        Histopathology. 2009; 54: 699-712
        • Curvers W.L.
        • Bohmer C.J.
        • Mallant-Hent R.C.
        • et al.
        Mucosal morphology in Barrett's esophagus: interobserver agreement and role of narrow band imaging.
        Endoscopy. 2008; 40: 799-805
        • Curvers W.L.
        • ten Kate F.J.
        • Krishnadath K.K.
        • et al.
        Low-grade dysplasia in Barrett's esophagus: overdiagnosed and underestimated.
        American Journal of Gastroenterology. 2010; 105: 1523-1530
        • Schnell T.G.
        • Sontag S.J.
        • Chejfec G.
        • et al.
        Long-term nonsurgical management of Barrett's esophagus with high-grade dysplasia.
        Gastroenterology. 2001; 120: 1607-1619
        • Schouten L.J.
        • Steevens J.
        • Huysentruyt C.J.
        • et al.
        Total cancer incidence and overall mortality are not increased among patients with Barrett's esophagus.
        Clinical Gastroenterology and Hepatology. 2011; 9: 754-761
        • Jung K.W.
        • Talley N.J.
        • Romero Y.
        • et al.
        Epidemiology and natural history of intestinal metaplasia of the gastresophageal junction and Barrett's esophagus: a population-based study.
        American Journal of Gastroenterology. 2011; 106: 1447-1455
        • Hvid-Jensen F.
        • Pedersen L.
        • Drewes A.M.
        • et al.
        Incidence of adenocarcinoma among patients with Barrett's esophagus.
        New England Journal of Medicine. 2011; 365: 1375-1383
        • Singh S.
        • Manickam P.
        • Amin A.V.
        • et al.
        Incidence of esophageal adenocarcinoma in Barrett's esophagus with low-grade dysplasia: a systematic review and meta-analysis.
        Gastrointestinal Endoscopy. 2014; 79: 897-909