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Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett's oesophagus: a prospective, international, randomised controlled trial.
Gut 2013; 62(1):15-21Gut

Abstract

BACKGROUND

White light endoscopy with random biopsies is the standard for detection of intestinal metaplasia (IM) and neoplasia in patients with Barrett's oesophagus (BO). Narrow band imaging (NBI) highlights surface patterns that correlate with IM and neoplasia in BO.

OBJECTIVE

To compare high-definition white light (HD-WLE) and NBI for detection of IM and neoplasia in BO.

DESIGN

International, randomised, crossover trial comparing HD-WLE and NBI. Patients referred for BO screening/surveillance at three tertiary referral centres were prospectively enrolled and randomised to HD-WLE or NBI followed by other procedures in 3-8 weeks. During HD-WLE, four quadrant biopsies every 2 cm, together with targeted biopsies of visible lesions (Seattle protocol), were obtained. During NBI examination, mucosal and vascular patterns were noted and targeted biopsies were obtained. All biopsies were read by a single expert gastrointestinal pathologist in a blinded fashion.

RESULTS

123 patients with BO (mean age 61; 93% male; 97% Caucasian) with mean circumferential and maximal extents of 1.8 and 3.6 cm, respectively, were enrolled. Both HD-WLE and NBI detected 104/113 (92%) patients with IM, but NBI required fewer biopsies per patient (3.6 vs 7.6, p<0.0001). NBI detected a higher proportion of areas with dysplasia (30% vs 21%, p=0.01). During examination with NBI, all areas of high-grade dysplasia and cancer had an irregular mucosal or vascular pattern.

CONCLUSIONS

NBI targeted biopsies can have the same IM detection rate as an HD-WLE examination with the Seattle protocol while requiring fewer biopsies. In addition, NBI targeted biopsies can detect more areas with dysplasia. Regular appearing NBI surface patterns did not harbour high-grade dysplasia/cancer, suggesting that biopsies could be avoided in these areas.

Authors+Show Affiliations

Division of Gastroenterology, Department of Veterans Affairs Medical Center, 4801 E Linwood Blvd, Kansas City, MO 64128, USA. psharma@kumc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22315471

Citation

Sharma, Prateek, et al. "Standard Endoscopy With Random Biopsies Versus Narrow Band Imaging Targeted Biopsies in Barrett's Oesophagus: a Prospective, International, Randomised Controlled Trial." Gut, vol. 62, no. 1, 2013, pp. 15-21.
Sharma P, Hawes RH, Bansal A, et al. Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett's oesophagus: a prospective, international, randomised controlled trial. Gut. 2013;62(1):15-21.
Sharma, P., Hawes, R. H., Bansal, A., Gupta, N., Curvers, W., Rastogi, A., ... Bergman, J. J. (2013). Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett's oesophagus: a prospective, international, randomised controlled trial. Gut, 62(1), pp. 15-21. doi:10.1136/gutjnl-2011-300962.
Sharma P, et al. Standard Endoscopy With Random Biopsies Versus Narrow Band Imaging Targeted Biopsies in Barrett's Oesophagus: a Prospective, International, Randomised Controlled Trial. Gut. 2013;62(1):15-21. PubMed PMID: 22315471.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett's oesophagus: a prospective, international, randomised controlled trial. AU - Sharma,Prateek, AU - Hawes,Robert H, AU - Bansal,Ajay, AU - Gupta,Neil, AU - Curvers,Wouter, AU - Rastogi,Amit, AU - Singh,Mandeep, AU - Hall,Matt, AU - Mathur,Sharad C, AU - Wani,Sachin B, AU - Hoffman,Brenda, AU - Gaddam,Srinivas, AU - Fockens,Paul, AU - Bergman,Jacques J, Y1 - 2012/02/07/ PY - 2012/2/9/entrez PY - 2012/2/9/pubmed PY - 2013/2/13/medline SP - 15 EP - 21 JF - Gut JO - Gut VL - 62 IS - 1 N2 - BACKGROUND: White light endoscopy with random biopsies is the standard for detection of intestinal metaplasia (IM) and neoplasia in patients with Barrett's oesophagus (BO). Narrow band imaging (NBI) highlights surface patterns that correlate with IM and neoplasia in BO. OBJECTIVE: To compare high-definition white light (HD-WLE) and NBI for detection of IM and neoplasia in BO. DESIGN: International, randomised, crossover trial comparing HD-WLE and NBI. Patients referred for BO screening/surveillance at three tertiary referral centres were prospectively enrolled and randomised to HD-WLE or NBI followed by other procedures in 3-8 weeks. During HD-WLE, four quadrant biopsies every 2 cm, together with targeted biopsies of visible lesions (Seattle protocol), were obtained. During NBI examination, mucosal and vascular patterns were noted and targeted biopsies were obtained. All biopsies were read by a single expert gastrointestinal pathologist in a blinded fashion. RESULTS: 123 patients with BO (mean age 61; 93% male; 97% Caucasian) with mean circumferential and maximal extents of 1.8 and 3.6 cm, respectively, were enrolled. Both HD-WLE and NBI detected 104/113 (92%) patients with IM, but NBI required fewer biopsies per patient (3.6 vs 7.6, p<0.0001). NBI detected a higher proportion of areas with dysplasia (30% vs 21%, p=0.01). During examination with NBI, all areas of high-grade dysplasia and cancer had an irregular mucosal or vascular pattern. CONCLUSIONS: NBI targeted biopsies can have the same IM detection rate as an HD-WLE examination with the Seattle protocol while requiring fewer biopsies. In addition, NBI targeted biopsies can detect more areas with dysplasia. Regular appearing NBI surface patterns did not harbour high-grade dysplasia/cancer, suggesting that biopsies could be avoided in these areas. SN - 1468-3288 UR - https://www.unboundmedicine.com/medline/citation/22315471/Standard_endoscopy_with_random_biopsies_versus_narrow_band_imaging_targeted_biopsies_in_Barrett's_oesophagus:_a_prospective_international_randomised_controlled_trial_ L2 - http://gut.bmj.com/cgi/pmidlookup?view=long&amp;pmid=22315471 DB - PRIME DP - Unbound Medicine ER -