de Groof AJ1, Fockens KN1, Struyvenberg MR1, Pouw RE1, Weusten BLAM2, Schoon EJ3, Mostafavi N4, Bisschops R5, Curvers WL3, Bergman JJ1.
Gastrointest Endosc. 2020 Jan 2. pii: S0016-5107(19)32579-9. doi: 10.1016/j.gie.2019.12.037. [Epub ahead of print]
Background and aims: Endoscopic recognition of early Barrett’s neoplasia is challenging. Blue-light imaging (BLI) and linked-color imaging (LCI) may assist endoscopists in appreciation of neoplasia. Our aim was to evaluate BLI and LCI for visualization of Barrett’s neoplasia in comparison with WLE alone, when assessed by nonexpert endoscopists.
Methods: In this web-based assessment, corresponding white-light endoscopy (WLE), BLI, and LCI images of 30 neoplastic Barrett’s lesions were delineated by 3 expert endoscopists to establish ground truth. These images were then scored and delineated by 76 nonexpert endoscopists from 3 countries and with different levels of expertise, in 4 separate assessment phases with a washout period of 2 weeks. Assessments were as follows: Assessment 1: WLE only; Assessment 2: WLE+BLI; Assessment 3: WLE+LCI; Assessment 4: WLE+BLI+LCI. The outcomes were (1) appreciation of macroscopic appearance and ability to delineate lesions (VAS-scores); (2) preferred technique (ordinal scores); and (3) assessors’ delineation performance in terms of overlap with expert ground truth.
Results: Median VAS scores for phases 2 to 4 were significantly higher than in phase 1 (P < 0.001). Assessors preferred BLI and LCI over WLE for appreciation of macroscopic appearance (P < 0.001) and delineation (P < 0.001). Linear mixed-effect models showed that delineation performance increased significantly in phase 4.
Conclusions: The use of BLI and LCI has significant additional value for the visualization of Barrett’s neoplasia, when used by nonexpert endoscopists. Assessors appreciated the addition of BLI and LCI better than the use of WLE alone. This addition furthermore led to improved delineation performance, thereby allowing for better targeted biopsy acquisition.
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 Biostatistical unit, department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
5 Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium