Autofluorescence Imaging and Narrow-Band Imaging for the Detection of Early Neoplasia in Patients with Barrett’s Esophagus

Introduction

Barrett’s esophagus is defined as an endoscopically visible, columnar epithelium-lined distal esophageal segment, with specialized intestinal metaplasia found in biopsy specimens. Barrett’s esophagus is recognized as a premalignant condition that predisposes to esophageal adenocarcinoma. The continuous rise in the incidence of this malignancy and its poor prognosis have driven research into finding techniques that enable early detection of neoplastic changes in Barrett’s esophagus [1] [2].

The current recommendation is to offer patients with Barrett’s esophagus regular endoscopic surveillance in order to detect neoplastic changes at an early and curable stage [3]. The effectiveness of this type of surveillance is hampered by several factors, however, including the subtlety of early neoplastic lesions, which makes them difficult to detect using standard endoscopic techniques. In order to improve the detection rate of neoplasia and the efficacy of endoscopic surveillance in patients with Barrett’s esophagus, various advanced imaging modalities have been investigated recently. These have included technologies that involve improvement of the resolution of the endoscopic white-light image (high-resolution endoscopy, HRE), techniques that incorporate optical magnification (magnifying endoscopy), and techniques based on the utilization of light with specific spectral characteristics. This last group of techniques includes autofluorescence imaging (AFI) and narrow-band imaging (NBI), and these are the focus of this article.

High-resolution endoscopes are equipped with charge-coupled devices with up to a million pixels. This improves the quality of the endoscope’s white-light image, allowing clear visualization of fine details, which may facilitate the detection of early neoplastic lesions. The newest prototype endoscopy systems that allow for autofluorescence endoscopy and NBI have an HRE mode incorporated, usually combined with the potential for optical magnification.

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