Читать книгу The Esophagus - Группа авторов - Страница 206

Electronic or digital chromoendoscopy offers the provider real‐time alternative imaging at the push of a button. Blue‐light imaging came into practice around 2006 and was marketed as NBI [9]. The electronic exchange from high‐definition white light endoscopy to NBI enhances the ability to see two basic features of BE epithelium: (i) ridge and villous features into repeating patterns or irregular and distorted areas and (ii) vascular patterns into regular or irregular. NBI has been extensively studied in BE. A cohort of international expert physicians forming the BING (Barrett’s International NBI Group) working group examined 50 NBI images followed by an additional 120 images to determine the validity of the simple binary classification of pit and vascular patterns as regular or irregular [10]. The group found a sensitivity of 80.4% and specificity of 88.4%. A recent report using blue‐light imaging (BLI) (Fujifilm, Tokyo, Japan) confirmed similar findings in 100 patients undergoing evaluation of suspected BE dysplasia; careful inspection of the color, mucosal pits, and crypts and vessels was able to reliably identify areas of neoplasia [11].

The i‐SCAN optical enhancement (OE) system (Pentax, Tokyo, Japan) has been studied in a recent prospective clinical trial of 41 patients with BE comparing high‐definition white light magnified using still images marked by seven trainees and seven experts [12]. The design of the study addressed the bias of many previous clinical trials using only experienced physicians. Mucosal and vascular changes were recorded in a standardized fashion, and neoplasia was defined by two unblinded experts by consensus. The OE system improved sensitivity, specificity, and positive predictive value in both trainees and experts. The authors also noted increased inter‐observer agreement, and these changes appeared clinically significant.

The Fuji Intelligent Chromoendoscopy System (FICE, Japan) has limited data but also shows improvement in detecting neoplasia in BE compared to high‐definition and AA [13].