High-resolution endoscopy with narrow band imaging enhances the visualization of mucosal glandular and vascular structures.
Dr Herbert Wolfsen and colleagues from Florida, USA assessed whether narrow band targeted biopsies could detect advanced dysplasia using fewer biopsy samples compared with standard resolution endoscopy.
The team conducted a prospective, blinded, tandem endoscopy study in a tertiary care center with 65 patients with Barrett's esophagus undergoing evaluation for previously detected dysplasia.
|57% had narrow band directed biopsies detected dysplasia in more patients|
Standard resolution endoscopy was used first to detect visible lesions.
Narrow band endoscopy was then used by another gastroenterologist to detect, and biopsy areas suspicious for dysplasia.
The lesions initially detected by standard resolution endoscopy were then disclosed and biopsied, after biopsy of the lesions targeted with narrow band imaging.
Finally, random 4-quadrant biopsies were taken throughout the segment of Barrett's mucosa.
The researchers identified higher grades of dysplasia by narrow band imaging in 18% patients.
The research team found no cases in whom standard resolution white light endoscopy with random biopsy detected a higher grade of histology.
Correspondingly, 57% had narrow band directed biopsies detected dysplasia in more patients compared with 43% of biopsies taken using standard resolution endoscopy.
In addition, more biopsies were taken using standard resolution endoscopy with random biopsy compared with narrow band targeted biopsies.
Dr Wolfsen's team concluded, "In patients evaluated for Barrett's esophagus with dysplasia, narrow band imaging detected significantly more patients with dysplasia and higher grades of dysplasia with fewer biopsy samples compared with standard resolution endoscopy."