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

Gastrointest Endosc. 2006 Aug;64(2):167-75. doi: 10.1016/j.gie.2005.10.044.


Background: A narrow band imaging (NBI) endoscopy system has been developed that allows superficial surface imaging of esophageal tissue in vivo.

Objective: The objective was to assess the potential of NBI for prediction of histology during screening and surveillance endoscopy in patients with Barrett's esophagus (BE).

Design: A prospective cohort study.

Setting: Veterans Affairs Medical Center.

Patients: Fifty-one patients with known or suspected BE.

Methods: NBI images were graded according to mucosal pattern (ridge/villous, circular and irregular/distorted) and vascular pattern (normal and abnormal), and correlated with histology in a prospective, blinded manner.

Main outcome measurements: Biopsy-confirmed intestinal metaplasia (IM) and dysplasia were used as the outcome measures.

Results: Of 51 patients (mean BE length 3.5 cm), 28 had IM without dysplasia, 8 had low-grade dysplasia (LGD), 7 had high-grade dysplasia (HGD), and 8 had cardiac-type mucosa. The sensitivity, specificity, and positive predictive value of ridge/villous pattern for diagnosis of IM without HGD were 93.5%, 86.7%, and 94.7%, respectively. The sensitivity, specificity, and positive predictive value of irregular/distorted pattern for HGD were 100%, 98.7%, and 95.3%, respectively. If biopsies were limited to areas with irregular/distorted pattern, no patient with HGD would have been missed. However, NBI was unable to distinguish areas of IM from those with LGD.

Limitations: The open study design without a control group was the main limitation.

Conclusions: NBI is a novel diagnostic tool with a high degree of accuracy for the detection of metaplastic and dysplastic tissue within the BE segment.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Barrett Esophagus / pathology*
  • Endoscopy, Gastrointestinal / methods*
  • Esophagus / blood supply
  • Esophagus / pathology*
  • Female
  • Humans
  • Image Enhancement
  • Male
  • Middle Aged
  • Mucous Membrane / blood supply
  • Mucous Membrane / pathology
  • Prospective Studies
  • Sensitivity and Specificity