Advanced endoscopic imaging in Barrett's oesophagus: a review on current practice

Abstract

Over the last few years, improvements in endoscopic imaging technology have enabled identification of dysplasia and early cancer in Barrett's oesophagus. New techniques should exhibit high sensitivities and specificities and have good interobserver agreement. They should also be affordable and easily applicable to the community gastroenterologist. Ideally, these modalities must exhibit the capability of imaging wide areas in real time whilst enabling the endoscopist to specifically target abnormal areas. This review will specifically focus on some of the novel endoscopic imaging modalities currently available in routine practice which includes chromoendoscopy, autofluorescence imaging and narrow band imaging.

Keywords: Autofluorescence imaging; Barrett’s oesophagus; Chromoendoscopy; High magnification endoscopy; Narrow band imaging.

Figure 1

Images of various advanced imaging modalities in Barrett’s oesophagus. A: Acetic acid used to visualise Barrett’s oesophagus, ridge pattern signifying Intestinal metaplasia; B: High magnification white light endoscopy-round pits in keeping with columnar mucosa without intestinal metaplasia; C: Corresponding area on image B seen with narrow band imaging (NBI) and magnification; D: High magnification white light endoscopy - absent pits in keeping with columnar mucosa with intestinal metaplasia; E: Corresponding area on image D seen with NBI and magnification; F: High magnification white light endoscopy - villous/ridge pits in keeping with columnar mucosa with intestinal metaplasia; G: Corresponding area on image F seen with NBI and magnification; H: White light endoscopy of Barrett’s cancer; I: Corresponding area on autoflourescence imaging; J: Abnormal area on NBI with magnification showing total distortion of the pit pattern.