The utility of a novel narrow band imaging endoscopy system in patients with Barrett's esophagus

Sharma, Prateek; Bansal, Ajay; Mathur, Sharad C.; Wani, Sachin; Cherian, Rachel; McGregor, Douglas H.; Higbee, April D.; Hall, Sandra; Weston, Allan P.

doi:10.1016/j.gie.2005.10.044

Cited by 331 publications

(235 citation statements)

References 34 publications

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“…11,12,18 Currently, imaging is largely a subjectively based process. However, further development of image software may provide means to quantify in vivo imaging.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7] Endoscopists are exploiting neovascularization in Barrett's esophagus to detect neoplasia using novel imaging modalities, such as narrow band imaging and confocal laser endomicroscopy. [8][9][10][11][12] One of the features that endoscopists look for is the vascular pattern under narrow band imaging or confocal laser endomicroscopy. [8][9][10][11][12] Irregular or increased vascularity is a feature that endoscopists are looking for with these imaging modalities to identify significant superficial neoplasia, including both high-grade dysplasia and esophageal adenocarcinoma.…”

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confidence: 99%

“…[8][9][10][11][12] One of the features that endoscopists look for is the vascular pattern under narrow band imaging or confocal laser endomicroscopy. [8][9][10][11][12] Irregular or increased vascularity is a feature that endoscopists are looking for with these imaging modalities to identify significant superficial neoplasia, including both high-grade dysplasia and esophageal adenocarcinoma.…”

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confidence: 99%

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Evaluation of microvascular density in Barrett's associated neoplasia

et al. 2013

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Angiogenesis has an important role in the carcinogenesis of esophageal adenocarcinoma, however, the diagnostic and prognostic utility of microvascular density counts have not been clinically established. The aim of this study is to assess the correlation between microvascular density and disease progression of non-dysplastic Barrett's esophagus, low-grade dysplasia, high-grade dysplasia and invasive carcinoma in the superficial aspects of the tissue. Archival histological specimens from two referral centers for Barrett's esophagus and esophageal cancer were selected for review. A total of 160 regions marked according to histological grade were assessed with digitally interactive software to measure microvascular density. This was quantified in three levels: 0-50, 50-100 and 100-150 lm. In the areas of gastric cardia, Barrett's esophagus, low-grade dysplasia, high-grade dysplasia and cancer, microvascular density was significantly different (Po0.0001) among the five groups in the most superficial 150 lm of the mucosa. Furthermore, when examining the pairwise difference between the groups, there was a significant difference between cancer and each of the lower grades of histology (Po0.05) and between high-grade dysplasia and each of the lower grades of histology (Po0.05). These statistically significant differences were preserved in examining the depth at the most superficial 50 lm. We have used digital pathology to demonstrate a significant and stepwise increase in microvascular density, which supports the hypothesis that angiogenesis has a key role in Barrett's carcinogenesis. Furthermore, the differences in the most superficial mucosal layers are consistent with findings of increased vascularity by depth-restricted imaging modalities. Modern Pathology (2013) 26, 125-130; doi:10.1038/modpathol.2012 published online 24 August 2012 Keywords: angiogenesis; Barrett's esophagus; esophageal cancer; microvascular density Angiogenesis has an important role in the carcinogenesis of esophageal adenocarcinoma, however, the diagnostic and prognostic utility of microvascular density counts have not been clinically established. 1,2 Esophageal adenocarcinoma arises from Barrett's esophagus in a metaplasia-dysplasia-carcinoma sequence. Intestinal metaplasia and dysplasia have been studied in terms of microvascular density, and neoangiogenesis is thought to begin in these precursor lesions. [3][4][5][6][7]

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“…11,12,18 Currently, imaging is largely a subjectively based process. However, further development of image software may provide means to quantify in vivo imaging.…”

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Evaluation of microvascular density in Barrett's associated neoplasia

et al. 2013

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“…Both of these technologies can be applied to Barrett's esophagus (60)(61)(62). In one study of 51 patients with Barrett's esophagus studied with NBI, 7 of whom had high grade dysplasia, the sensitivity of NBI detection for a irregular mucosal pattern was 100% with a specificity of 98.7% (63). However, studies regarding the interobserver variation in interpretation of these patterns has not been studied.…”

Section: Imaging In Barrett's Esophagusmentioning

confidence: 99%

Updated Guidelines 2008 for the Diagnosis, Surveillance and Therapy of Barrett's Esophagus

Sampliner

2008

The American Journal of Gastroenterology

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893

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PREAMBLEThe guidelines for the diagnosis, surveillance and therapy of Barrett's esophagus were originally published by the American College of Gastroenterology in 1998 and updated in 2002. These and other guidelines undergo periodic review. Significant advances have occurred in the area of Barrett's esophagus over the past four years leading to another revision of the prior guidelines. These advances include the potential use of esophageal capsule endoscopy for the diagnosis and screening of Barrett's esophagus, data regarding the outcome of low-grade dysplasia, the treatment of high-grade dysplasia using photodynamic therapy, and the development of new ablation techniques such as radiofrequency ablation. These guidelines are intended to be applied by physicians who see Barrett's esophagus patients and are intended to indicate a preferred, but certainly not the only, acceptable approach. Physicians need to choose the course best suited to the individual patient and to the variables that exist at the time of decision making. The guidelines are for adult patients with the diagnosis of Barrett's esophagus, as defined herein.Both these and the original guidelines were developed under auspices of the American College of Gastroenterology and the Practice Parameters Committee and approved by the Board of Trustees. The world literature was reviewed extensively for the original guidelines and once again reviewed using the National Library of Medicine database. Search terms used included Barrett's esophagus, esophageal neoplasm, esophagus, intestinal metaplasia, esophageal diseases, and adenocarcinoma, all appropriate studies and any additional ones found in reference to these papers were obtained and reviewed. Evidence was available from a hierarchy of trials and randomized controlled trials were given the greatest weight. Abstracts presented at national and international meetings were only used when unique data from ongoing trials were presented. When scientific data were lacking, recommendations are based on expert opinion. The recommendations made are based on the level of evidence found. Grade A recommendations imply that there is consistent level 1 evidence (randomized controlled trials), Grade B indicates that the evidence would be level 2 or 3 which are cohort studies or case control studies. Grade C recommendations are based on level 4 studies meaning case series or poor quality cohort studies, and Grade D recommendations are based on level 5 evidence meaning expert opinion.

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“…Regarding the choice of imaging modality, high-definition imaging is superior to standard-definition imaging for BE. For example, narrowband imaging (NBI) enables evaluation of the mucosal patterns superior to that of conventional endoscopic imaging with a reported sensitivity of 100 % and a specificity of 98.7 % [5], due to the identification of abnormal pit and vasculature patterns within the mucosa. Thus, the combination of additional time spent assessing the mucosa along with advanced imaging through improved targeting of biopsies provides a greater probability of identifying BE, dysplasia, and EAC.…”

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From Prague to Seattle: Improved Endoscopic Technique and Reporting Improves Outcomes in Patients with Barrett’s Esophagus

Brown

2015

Dig Dis Sci

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Endoscopic screening and surveillance practices in patients with Barrett's esophagus (BE) remain controversial. No randomized, controlled trials have supported decreased mortality as a result of these programs, but given evidence from cohort and retrospective studies combined with the rapidly rising incidence of esophageal adenocarcinoma (EAC), some GI societies have weakly recommended screening and surveillance endoscopy for BE patients [1]. The goal of the initial endoscopy is to detect BE and, if detected, to grade and evaluate for the presence of dysplasia and EAC.In this issue of Digestive Diseases and Sciences, Visrodia et al. [2] report the proportion of cases of ''missed dysplasia'' diagnosed at repeat endoscopy in comparison with the index endoscopy findings. In this retrospective study, patients who underwent initial endoscopy from 1976 to 2011, with diagnosed BE of length 1 cm or greater, i.e., columnar mucosa with intestinal metaplasia, and who had undergone repeat endoscopy within 24 months of the index examination, were included in the analysis. Notably, the rate of missed high-grade dysplasia and EAC was 1.9 %, whereas the overall rate of missed dysplasia of any grade and/or EAC was 9.5 %. While the study has limitations, including its retrospective nature, questionable adherence to guidelines, adequate number of biopsies, and the types of endoscopes used, it does highlight an important issuethe importance of meticulous endoscopy and biopsy at the time of index endoscopy in BE patients.If during index endoscopy BE is confirmed or suspected, the extent of BE should be carefully documented using the Prague C&M criteria. As part of this exercise, the landmarks that should be evaluated include the squamocolumnar junction, the gastroesophageal junction, and the extent of BE. Since this classification describes the circumferential (C) columnar lining and the maximum length (M) of BE, excluding islands [1], in this fashion it provides a standardized description of BE, useful for comparison with subsequent endoscopic evaluations. It also facilitates communication among gastroenterologists when patients are referred to tertiary centers for treatment. Despite the benefits of the Prague classification, a recent study reported that a surprising 78 % of gastroenterologists across varying practice settings did not use the Prague classification [3].Other considerations during index endoscopy that increase the value of the examination are careful inspection of the BE mucosa, the time spent in its evaluation, and the choice of imaging modalities. For instance, longer inspection times during endoscopic evaluation are associated with higher detection rates for HGD. A recent study reported that when endoscopists spent *1 min/cm extent of BE, the detection rate for neoplastic lesions improved [4]. Regarding the choice of imaging modality, high-definition imaging is superior to standard-definition imaging for BE. For example, narrowband imaging (NBI) enables evaluation of the mucosal patterns superior to that of conven...

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The utility of a novel narrow band imaging endoscopy system in patients with Barrett's esophagus

Cited by 331 publications

References 34 publications

Evaluation of microvascular density in Barrett's associated neoplasia

Evaluation of microvascular density in Barrett's associated neoplasia

Updated Guidelines 2008 for the Diagnosis, Surveillance and Therapy of Barrett's Esophagus

From Prague to Seattle: Improved Endoscopic Technique and Reporting Improves Outcomes in Patients with Barrett’s Esophagus

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