Endoscopic trimodal imaging versus standard video endoscopy for detection of early Barrett's neoplasia: a multicenter, randomized, crossover study in general practice

Gastrointest Endosc. 2011 Feb;73(2):195-203. doi: 10.1016/j.gie.2010.10.014. Epub 2010 Dec 18.


Background: Endoscopic trimodal imaging (ETMI) may improve detection of early neoplasia in Barrett's esophagus (BE). Studies with ETMI so far have been performed in tertiary referral settings only.

Objective: To compare ETMI with standard video endoscopy (SVE) for the detection of neoplasia in BE patients with an intermediate-risk profile.

Design: Multicenter, randomized, crossover study.

Setting: Community practice.

Patients and methods: BE patients with confirmed low-grade intraepithelial neoplasia (LGIN) underwent both ETMI and SVE in random order (interval 6-16 weeks). During ETMI, BE was inspected with high-resolution endoscopy followed by autofluorescence imaging (AFI). All visible lesions were then inspected with narrow-band imaging. During ETMI and SVE, visible lesions were sampled followed by 4-quadrant random biopsies every 2 cm.

Main outcome measurements: Overall histological yield of ETMI and SVE and targeted histological yield of ETMI and SVE.

Results: A total of 99 patients (79 men, 63±10 years) underwent both procedures. ETMI had a significantly higher targeted histological yield because of additional detection of 22 lesions with LGIN/high-grade intraepithelial neoplasia (HGIN)/carcinoma (Ca) by AFI. There was no significant difference in the overall histological yield (targeted+random) between ETMI and SVE. HGIN/Ca was diagnosed only by random biopsies in 6 of 24 patients and 7 of 24 patients, with ETMI and SVE, respectively.

Limitations: Inspection, with high-resolution endoscopy and AFI, was performed sequentially.

Conclusion: ETMI performed in a community-based setting did not improve the overall detection of dysplasia compared with SVE. The diagnosis of dysplasia is still being made in a significant number of patients by random biopsies. Patients with a confirmed diagnosis of LGIN have a significant risk of HGIN/Ca. (

Clinical trial registration number: ISRCTN91816824; NTR867.).

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Barrett Esophagus / diagnosis*
  • Cross-Over Studies
  • Diagnosis, Differential
  • Early Diagnosis*
  • Endoscopy, Gastrointestinal / methods*
  • Female
  • Follow-Up Studies
  • General Practice / methods*
  • Humans
  • Image Enhancement / methods*
  • Intestinal Mucosa / pathology*
  • Male
  • Middle Aged
  • Reproducibility of Results
  • Retrospective Studies
  • Video Recording*

Associated data

  • ISRCTN/ISRCTN91816824