Curvers WL et al. (2008) 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. Gut 57: 167–172

Early detection of esophageal adenocarcinoma in patients with Barrett's esophagus greatly improves prognosis; however, surveillance with standard endoscopic techniques can fail to detect early neoplasms. Curvers and colleagues evaluated the diagnostic potential of a trimodal endoscopic imaging protocol for detecting high-grade intraepithelial neoplasia (HGIN) in patients with Barrett's esophagus.

This international, multicenter, feasibility study included 84 patients (mean age 67 years, 70 men) with Barrett's esophagus. Patients were first examined with high-resolution endoscopy (HRE), and any abnormalities suspicious for early neoplasia recorded. Autofluorescence imaging (AFI) was then used to examine the Barrett's segment for further lesions. All suspicious lesions detected with HRE and/or AFI underwent detailed investigation with narrow-band imaging (NBI).

AFI identified all 16 patients with early neoplasia detected by HRE, and discovered HGIN in 11 additional patients who were not identified by HRE. On per-lesion analysis, AFI detected 102 lesions in addition to those detected by HRE, of which only 19 contained HGIN (81% false-positive rate for AFI after HRE); however, NBI findings suggested that 27 of the 83 false-positive AFI lesions were suspicious for HGIN; NBI reduced the false-positive rate of AFI from 81% to 26%.

The authors conclude that endoscopic trimodal imaging is a feasible method of detecting early neoplasia in patients with Barrett's esophagus; however, randomized, controlled trials are necessary to characterize the true diagnostic potential of this technique.