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Compared to standard devices and use of random biopsy samples, use of endoscopes with narrow band imaging is better at detecting areas of Barrett's esophagus, researchers report.

Compared to standard devices and use of random biopsy samples, use of high resolution endoscopes with narrow band imaging (NBI) is significantly better at detecting pre-cancerous areas of Barrett's esophagus, researchers report in the July issue of Gastroenterology.

"In the field of gastrointestinal endoscopy," lead investigator Dr. Herbert C. Wolfsen told Reuters Health, "there has been a steady progression in the development of advanced imaging technologies with improved imaging resolution and enhanced capability to visualize distorted glands and blood vessel patterns on the surface of the gut lining, such as NBI."

Dr. Wolfsen of the Mayo Clinic, Jacksonville, Florida and colleagues conducted a prospective blinded tandem endoscopy study in 65 patients undergoing evaluation of previously detected dysplasia.

Standard resolution endoscopy was used to detect visible lesions and take random biopsies, and then another gastroenterologist employed the NBI approach to detect and biopsy suspicious areas.

A mean of 4.7 biopsies were taken via NBI compared to 8.5 random biopsies when standard endoscopy was used. In addition, NBI-directed biopsies found dysplasia in 37 patients (57 per cent) compared to 28 (43 per cent) with the standard method.

Moreover, 12 patients (18 per cent) showed high grades of dysplasia via NBI, while none were found via standard endoscopy and random biopsy.

"The results of our study will need to be confirmed by other investigators," stressed Dr. Wolfsen, "and these findings cannot be extrapolated to other settings." Further studies, he added, are ongoing.

In an accompanying editorial, Dr. Jacques J. Bergman and Wouter L. Curvers of Academic Medical Center, Amsterdam, The Netherlands note that the study "is a step on the way from standard endoscopy with random sampling to multimodality imaging by endoscopists who, as a result, will be looking longer, seeing better, and recognizing more."

Gastroenterology 2008;135:24-31