Prospective, controlled tandem endoscopy study of narrow band imaging for dysplasia detection in Barrett's Esophagus
Prospective, controlled tandem endoscopy study of narrow band imaging for dysplasia detection in Barrett's Esophagus
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DOI：
10.1053/j.gastro.2008.03.019
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发表时间：
2008-07-01
期刊：
影响因子：
29.4
通讯作者：
Wallace, Michael B.
中科院分区：
文献类型：
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作者：
Wolfsen, Herbert C.;Crook, Julia E.;Wallace, Michael B.
背景与目的：窄带成像（NBI）的高分辨率内窥镜增强了粘膜腺体和血管结构的可视化。本研究评估了窄带靶向活检与标准分辨率内镜相比是否可以使用更少的活检样本检测晚期异型增生。研究方法：我们在一家三级医疗中心进行了一项前瞻性、双盲、串联内窥镜研究，其中65例Barrett食管患者接受了先前检测到的异型增生评估。首先使用标准分辨率内镜检查可见病变。然后由另一位胃肠病学家使用窄带内镜检查可疑异型增生区域并进行活检。然后，在对NBI靶向病变进行活检后，对标准分辨率内窥镜最初检测到的病变进行显示和活检。最后，在Barrett粘膜的整个节段中进行随机的4象限活检。结果如下：NBI发现12例患者（18%）的异型增生级别较高，而标准分辨率白色光内镜随机活检未发现异型增生级别较高的病例（0%）（P <0.001）。相应地，窄带定向活检检测到更多患者的异型增生（n = 37; 57%）相比，采用标准分辨率内镜活检（n = 28; 43%）。此外，与窄带靶向活检相比，使用标准分辨率内镜随机活检进行更多活检（平均8.5 vs 4.7; P <0.001）。结论：与标准分辨率内窥镜相比，在评估巴雷特食管发育不良的患者中，NBI检测到明显更多的发育不良患者和更高级别的发育不良，而活检样本更少。
Background & Aims: High-resolution endoscopy with narrow band imaging (NBI) enhances the visualization of mucosal glandular and vascular structures. This study assessed whether narrow band targeted biopsies could detect advanced dysplasia using fewer biopsy samples compared with standard resolution endoscopy. Methods: We 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. 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 NBI. Finally, random 4-quadrant biopsies were taken throughout the segment of Barrett's mucosa. Results: Higher grades of dysplasia were found by NBI in 12 patients (18%), compared with no cases (0%) in whom standard resolution white light endoscopy with random biopsy detected a higher grade of histology (P < .001). Correspondingly, narrow band directed biopsies detected dysplasia in more patients (n = 37; 57%) compared with biopsies taken using standard resolution endoscopy (n = 28; 43%). In addition, more biopsies were taken using standard resolution endoscopy with random biopsy compared with narrow band targeted biopsies (mean 8.5 versus 4.7; P < .001). Conclusions: in patients evaluated for Barrett's esophagus with dysplasia, NBI detected significantly more patients with dysplasia and higher grades of dysplasia with fewer biopsy samples compared with standard resolution endoscopy.