Background and study aims: High- resolution endoscopy (HRE) may improve the detection of early neoplasia in Barrett s esophagus. Indigo carmine chromoendoscopy (ICC) and narrow- band imaging (NBI) may be useful tech...Background and study aims: High- resolution endoscopy (HRE) may improve the detection of early neoplasia in Barrett s esophagus. Indigo carmine chromoendoscopy (ICC) and narrow- band imaging (NBI) may be useful techniques to complement HRE. The aim of this study was to compare HRE- ICC with HRE- NBI for the detection of high- grade dysplasia or early cancer (HGD/EC) in patients with Barrett s esophagus. Patients and methods: Twenty- eight patients with Barrett s esophagus underwent HRE- ICC and HRE- NBI (separated by 6- 8weeks) in a randomized sequence. The two procedures were performed by two different endoscopists, who were blinded to the findings of the other examination. Targeted biopsies were taken from all detected lesions, followed by four- quadrant biopsies at 2- cm intervals. Biopsy evaluation was supervised by a single expert pathologist, who was blinded to the imaging technique used. Results: Fourteen patients were diagnosed with HGD/EC. The sensitivity for HGD/EC was 93 % and 86% for HRE- ICC and HRE- NBI, respectively. Targeted biopsies had a sensitivity of 79% with HRE alone. HGD was diagnosed from random biopsies alone in only one patient. ICC and NBI detected a limited number of additional lesions occult to HRE, but these lesions did not alter the sensitivity for identifying patients with HGD/EC. Conclusions: In most patients with high- grade dysplasia or early cancer in Barrett s esophagus, subtle lesions can be identified with high- resolution endoscopy. Indigo carmine chromoendoscopy and narrow- band imaging are comparable as adjuncts to high- resolution endoscopy.展开更多
Background: The aim of this study was to investigate the feasibility of detecting high-grade dysplasia (HGD) and early cancer (EC) in Barrett’s esophagus (BE) with a prototype video autofluorescence endoscope. Method...Background: The aim of this study was to investigate the feasibility of detecting high-grade dysplasia (HGD) and early cancer (EC) in Barrett’s esophagus (BE) with a prototype video autofluorescence endoscope. Methods: Sixty patients with BE were evaluated with a prototype, high-resolution video-endoscope that has separate charge-coupled devices for white light endoscopy (WLE) and autofluorescence imaging (AFI). Nondysplastic BE appears green on AFI, whereas potentially neoplastic areas appear blue/violet. The BE was first screened with WLE for visible abnormalities and then was examined by AFI to detect additional lesions. Lesions that raised a suspicion of neoplasia and control areas that were normal on AFI were sampled for histopathologic assessment. Finally, random 4-quadrant biopsy specimens were obtained at 2-cm intervals. Results: A diagnosis of HGD/EC was made in 22 patients; one patient had no visible abnormality, and 21 had endoscopically detectable areas with HGD/EC. In 6 of the latter 21 patients, the HGD/EC was detected with AFI alone; in another patient, HGD/EC was detected with AFI and random biopsies. In 14 patients, HGD/EC was detected with both WLE and AFI; in 3 of these 14 patients, additional lesions containing HGD/EC were detected by AFI alone. Conclusions: The results of this study suggest that video AFI may improve the detection of HGD/EC in patients with BE.展开更多
Background: Light-induced fluorescence endoscopy (LIFE)-may improve the detection of high-grade dysplasia (HGD) and early stage cancer (EC) in Barrett’s esophagus (BE). The aim of this study was to compare LIFE with ...Background: Light-induced fluorescence endoscopy (LIFE)-may improve the detection of high-grade dysplasia (HGD) and early stage cancer (EC) in Barrett’s esophagus (BE). The aim of this study was to compare LIFE with standard endoscopy (SE) in a randomized crossover study. Methods: Fifty patients with BE underwent SE and LIFE in a randomized sequence (4 to 6-week interval between procedures). The two procedures were performed by two different endoscopists who were blinded to the findings of the other examination. Targeted biopsy specimens were taken from detected lesions, followed by random biopsy specimens with a 2 cm interval, 4-quadrant protocol. Biopsy specimens were routinely evaluated and subsequently reviewed by a single, blinded expert GI pathologist. Results: Targeted biopsy specimens had a sensitivity for the diagnosis of HGD/EC of 62%(8/13) for both techniques. The overall sensitivity (all biopsy specimens) was 85%for SE and 69%for LIFE (p = 0.69). All targeted biopsy specimens had a positive predictive value (PPV) for HGD/EC of 41%for SE and 28%for LIFE (p = 0.40); autofluorescence-targeted biopsy specimens had a PPV of 13%. False-positive lesions had a significantly higher rate of acute inflammation than random biopsy specimens. Conclusions: In this study, LIFE did not improve the detection of HGD or EC in patients with BE compared with SE.展开更多
文摘Background and study aims: High- resolution endoscopy (HRE) may improve the detection of early neoplasia in Barrett s esophagus. Indigo carmine chromoendoscopy (ICC) and narrow- band imaging (NBI) may be useful techniques to complement HRE. The aim of this study was to compare HRE- ICC with HRE- NBI for the detection of high- grade dysplasia or early cancer (HGD/EC) in patients with Barrett s esophagus. Patients and methods: Twenty- eight patients with Barrett s esophagus underwent HRE- ICC and HRE- NBI (separated by 6- 8weeks) in a randomized sequence. The two procedures were performed by two different endoscopists, who were blinded to the findings of the other examination. Targeted biopsies were taken from all detected lesions, followed by four- quadrant biopsies at 2- cm intervals. Biopsy evaluation was supervised by a single expert pathologist, who was blinded to the imaging technique used. Results: Fourteen patients were diagnosed with HGD/EC. The sensitivity for HGD/EC was 93 % and 86% for HRE- ICC and HRE- NBI, respectively. Targeted biopsies had a sensitivity of 79% with HRE alone. HGD was diagnosed from random biopsies alone in only one patient. ICC and NBI detected a limited number of additional lesions occult to HRE, but these lesions did not alter the sensitivity for identifying patients with HGD/EC. Conclusions: In most patients with high- grade dysplasia or early cancer in Barrett s esophagus, subtle lesions can be identified with high- resolution endoscopy. Indigo carmine chromoendoscopy and narrow- band imaging are comparable as adjuncts to high- resolution endoscopy.
文摘Background: The aim of this study was to investigate the feasibility of detecting high-grade dysplasia (HGD) and early cancer (EC) in Barrett’s esophagus (BE) with a prototype video autofluorescence endoscope. Methods: Sixty patients with BE were evaluated with a prototype, high-resolution video-endoscope that has separate charge-coupled devices for white light endoscopy (WLE) and autofluorescence imaging (AFI). Nondysplastic BE appears green on AFI, whereas potentially neoplastic areas appear blue/violet. The BE was first screened with WLE for visible abnormalities and then was examined by AFI to detect additional lesions. Lesions that raised a suspicion of neoplasia and control areas that were normal on AFI were sampled for histopathologic assessment. Finally, random 4-quadrant biopsy specimens were obtained at 2-cm intervals. Results: A diagnosis of HGD/EC was made in 22 patients; one patient had no visible abnormality, and 21 had endoscopically detectable areas with HGD/EC. In 6 of the latter 21 patients, the HGD/EC was detected with AFI alone; in another patient, HGD/EC was detected with AFI and random biopsies. In 14 patients, HGD/EC was detected with both WLE and AFI; in 3 of these 14 patients, additional lesions containing HGD/EC were detected by AFI alone. Conclusions: The results of this study suggest that video AFI may improve the detection of HGD/EC in patients with BE.
文摘Background: Light-induced fluorescence endoscopy (LIFE)-may improve the detection of high-grade dysplasia (HGD) and early stage cancer (EC) in Barrett’s esophagus (BE). The aim of this study was to compare LIFE with standard endoscopy (SE) in a randomized crossover study. Methods: Fifty patients with BE underwent SE and LIFE in a randomized sequence (4 to 6-week interval between procedures). The two procedures were performed by two different endoscopists who were blinded to the findings of the other examination. Targeted biopsy specimens were taken from detected lesions, followed by random biopsy specimens with a 2 cm interval, 4-quadrant protocol. Biopsy specimens were routinely evaluated and subsequently reviewed by a single, blinded expert GI pathologist. Results: Targeted biopsy specimens had a sensitivity for the diagnosis of HGD/EC of 62%(8/13) for both techniques. The overall sensitivity (all biopsy specimens) was 85%for SE and 69%for LIFE (p = 0.69). All targeted biopsy specimens had a positive predictive value (PPV) for HGD/EC of 41%for SE and 28%for LIFE (p = 0.40); autofluorescence-targeted biopsy specimens had a PPV of 13%. False-positive lesions had a significantly higher rate of acute inflammation than random biopsy specimens. Conclusions: In this study, LIFE did not improve the detection of HGD or EC in patients with BE compared with SE.
