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Feasibility of a simplified narrow-band imaging classification system for Barrett’s esophagus for novice endoscopists
摘要： Background Narrow-band imaging (NBI) classifications for Barrett’s esophagus have been proposed for the detection of early esophageal adenocarcinoma. We developed a simplified classification system with demonstrated high diagnostic accuracy and reproducibility among experienced endoscopists, but the feasibility of this system among novice endoscopists was unclear. Methods In the present study, eight novice endoscopists with no experience of magnification endoscopy were asked to review 248 images of Barrett’s esophagus (72 dysplastic, 176 non-dysplastic) obtained using high-definition magnification endoscopy with NBI 6 weeks before (1st test), immediately after (2nd test), and 6 weeks after (3rd test) being taught the simplified classification system. The primary outcomes were differences in diagnostic accuracy for dysplasia among the three tests. Results The specificity and overall accuracy improved significantly in the 2nd vs. 1st test [97% vs. 80% (p < 0.001) and 94% vs. 82% (p < 0.001), respectively], sensitivity was comparable (87% in both tests; p = 0.42). In the 3rd test, the sensitivity and overall accuracy decreased significantly compared with the 2nd test [82% vs. 87% (p < 0.001) and 93% vs. 94% (p < 0.05), respectively], but there was no significant difference in specificity (97% in both tests; p = 0.16). The kappa values for interobserver agreement for the mucosal pattern, vascular pattern, and predicted histology were substantial, and improved significantly in the 2nd vs. 1st test (0.78 vs. 0.59, 0.70 vs. 0.53, and 0.79 vs. 0.66, respectively; p < 0.001 for all). Conclusions The simplified NBI classification system may be appropriate for novice endoscopists to use in providing high accuracy and reproducibility.
关键词： Narrow-band imaging,Magnification endoscopy,Barrett’s esophagus,Classification,Esophageal adenocarcinoma
更新于2025-09-23 15:23:52
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Blue-light imaging has an additional value to white-light endoscopy in visualization of early Barrett's neoplasia: an international multicenter cohort study
摘要： Endoscopic features of early neoplasia in Barrett’s esophagus (BE) are subtle. Blue-light imaging (BLI) may improve visualization of neoplastic lesions. The aim of this study was to evaluate BLI in visualization of Barrett’s neoplasia. Methods: Corresponding white-light endoscopy (WLE) and BLI images of 40 BE lesions were obtained prospectively and assessed by 6 international experts in 3 assessments. Each assessment consisted of overview and magnification images. Assessments were as follows: assessment 1, WLE only; assessment 2, BLI only; and assessment 3, corresponding WLE and BLI images. Outcome parameters were as follows: (1) appreciation of macroscopic appearance and surface relief (visual analog scale scores); (2) ability to delineate lesions (visual analog scale scores); (3) preferred technique for delineation (ordinal scores); and (4) quantitative agreement on delineations (AND/OR scores). Results: Experts appreciated BLI significantly better than WLE for visualization of macroscopic appearance (median 8.0 vs 7.0, P < .001) and surface relief (8.0 vs 6.0, P < .001). For both overview and magnification images, experts appreciated BLI significantly better than WLE for ability to delineate lesions (8.0 vs 6.0, P < .001 and 8.0 vs 5.0, P < .001). There was no overall significant difference in AND/OR scores of WLE + BLI when compared with WLE, yet agreement increased significantly with WLE + BLI for cases with a low baseline AND/OR score on WLE, both in overview (mean difference, 0.15; P = .015) and magnification (mean difference, 0.10; P = .01). Conclusions: BLI has additional value for visualization of BE neoplasia. Experts appreciated BLI better than WLE for visualization and delineation of BE neoplasia. Quantitative agreement increased significantly when BLI was offered next to WLE for lesions that were hard to delineate with WLE alone.
关键词： neoplasia,white-light endoscopy,visualization,Barrett's esophagus,delineation,blue-light imaging
更新于2025-09-23 15:23:52
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Revisiting Barrett's Esophagus || Endoscopic Treatments: Photodynamic Therapy
摘要： Photodynamic therapy (PDT) is a technique developed in 1990 for reducing the severity of tumor symptoms and cancer size. It acts through a non-thermal mechanism utilizing the activation of a photosensitizer—administrated by intravenous, topical, or oral route—with a specific wavelength of light. The excited photosensitizer generates oxygen radicals which induces localized necrosis and cellular damage in the site of photoactivation. Site and depth of injury depended on several factors, including oxygen concentration, type of sensitizing agent, waiting time between dosing and light stimulation, energy per unit area, intensity of light dosimetry, wavelength, and time of irradiation. PDT may be used in the tissues accessible to light exposure, such as skin, retina, bronchial tree, and the gastrointestinal tract, for either palliative approach (namely lumen obstruction by lung and esophageal tract cancer) or curative therapy. In the gastrointestinal tract, PDT is thought to be effective in the treatment of Barrett’s esophagus with high-grade dysplasia. Further investigational applications include palliative approach to unresectable cholangiocarcinoma and treatment of duodenal or colon adenomas associated to FAP syndrome. Finally, there are few data on ablation of gastric superficial tumors. This review focused on PDT tools, indications, limits, and contraindications in the treatment of Barrett’s esophagus.
关键词： Light,Barrett’s esophagus,Gastrointestinal tract,Photosensitizer,Photodynamic therapy
更新于2025-09-23 15:21:01
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Su2058 – Interpretation of Volumetric Laser Endomicroscopy in Barrett’s Esophagus Using Image Enhancement Software
摘要： Volumetric laser endomicroscopy (VLE) is a second-generation optical coherence tomography platform that provides comprehensive imaging of Barrett's esophagus (BE). In-depth interpretation of a full VLE scan is complicated by subtle feature variations across a large amount of data (1200 frames). Intelligent real-time image segmentation (IRIS) is an artificial intelligence based image processing software that highlights established VLE features using a color-graded scale superimposed over cross-sectional and reconstructed en-face views. IRIS features include (1) surface hyper-reflectivity (signal attenuation), a pink graded color scale at the epithelial surface, (2) hypo-reflective structures (epithelial glands), filled by a solid blue color, and (3) lack of layered architecture, represented by an orange graded color bar at the external rim of the VLE image. This study aims to provide a description of IRIS features of various gastroesophageal tissue types using histologic correlation.
关键词： Volumetric laser endomicroscopy,Barrett's esophagus,IRIS,histologic correlation
更新于2025-09-16 10:30:52
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Virtual chromoendoscopy by using optical enhancement improves the detection of Barrett’s esophagus–associated neoplasia
摘要： The Seattle protocol for endoscopic Barrett’s esophagus (BE) surveillance samples a small portion of the mucosal surface area, risking a potentially high miss rate of early neoplastic lesions. We assessed whether the new iScan Optical Enhancement system (OE) improves the detection of early BE-associated neoplasia compared with high-definition white-light endoscopy (HD-WLE) in both expert and trainee endoscopists to target sampling of suspicious areas. Such a system may both improve early neoplasia detection and reduce the need for random biopsies.
关键词： Barrett’s esophagus,endoscopy,iScan,optical enhancement,dysplasia detection
更新于2025-09-04 15:30:14