Blue-light imaging has an additional value to white-light endoscopy in visualization of early Barrett’s neoplasia. an international multicenter cohort study.

de Groof AJ1, Swager A1, Pouw RE1, Weusten BLAM2, Schoon EJ3, Bisschops R4, Pech O5, Meining A6, Neuhaus H7, Curvers WL3, Bergman JJ1.

Gastrointest Endosc. 2018 Nov 9. pii: S0016-5107(18)33259-0. doi: 10.1016/j.gie.2018.10.046. [Epub ahead of print]

Background and aims: 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 (VAS-scores); (2) ability to delineate lesions (VAS-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<0.001) and surface relief (8.0 vs 6.0, P<0.001). For both overview and magnification images, experts appreciated BLI significantly better than WLE for ability to delineate lesions (8.0 vs 6.0, P<0.001 and 8.0 vs 5.0, P<0.001). 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=0.015) and magnification (mean difference 0.10, P=0.01).

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.

1 Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
2 Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands.
3 Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands.
4 Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
5 Gastroenterology and interventional Endoscopy, Krankenhaus Barmherzige Brüder, Regensburg, Germany.
6 Center of Internal Medicine, Ulm University, Ulm, Germany
7 Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany