Editor’s Choice- Dr. Jenifer Lightdale

Associate Editor, Jenifer Lightdale, MD, MPH, recommends the article “Clinical utility and interobserver agreement of autofluorescence imaging and magnification narrow-band imaging for the evaluation of Barrett’s esophagus: a prospective tandem study” by Giacchino et al from the May issue of GIE.

In this study, the authors investigated autofluorescence imaging (AFI) and magnification narrow band imaging (NBI) for the detection of early neoplasia in Barrett’s esophagus. In previous studies, AFI was used after white light endoscopy (WLE) for additional detection of lesions, while NBI was used for detailed characterization of lesions detected with both WLE and AFI. In the current study, inspection with WLE of Barrett’s was performed first, followed by AFI. All lesions detected with WLE were excluded from the analysis. Subsequently inspection with magnification NBI was performed of all areas with abnormal AFI that were not seen with WLE. All areas with abnormal AFI and/or NBI were sampled followed by random samples every 1-2 cm. Subsequently an interobserver agreement study was performed from a selection of AFI and NBI images. The results showed disappointing sensitivities of AFI and NBI for detecting neoplasia in Barrett’s, as well as lackluster inter-observer agreement.

Despite technological advances in endoscopic imaging, white light endoscopy with random biopsies remains the best available technique for BE surveillance.

A, Sample of an abnormal autofluorescence image. The corresponding histology showed high-grade dysplasia. B, Sample of a normal autofluorescence image. The corresponding histology showed intestinal metaplasia.

This study  illustrates the following important truths: (1) Well-designed rigorous studies are critical for evaluating the clinical importance of new endoscopic technologies; (2) Optimal imaging for Barrett’s esophagus remains a goal, with technologies today building upon each other, but none yet proving to be a disruptive advance; and (3) It remains fortunate that we have our wonderful journal, Gastrointestinal Endoscopy, to serve as the perfect place to publish a study like this, which answers important questions about the utility of advances in endoscopic imaging honestly, in a well-designed clinical research study!

Read the abstract of the article here.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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