Endoscopic video autofluorescence imaging may improve the detection of early neoplasia in patients with Barrett's esophagus

Background: The aim of this study was to investigate the feasibility of detecting high-grade dysplasia (HGD) and early cancer (EC) in Barrett's esophagus (BE) with a prototype video autofluorescence endoscope. Methods: Sixty patients with BE were evaluated with a prototype, high-resolution videoendoscope that has separate charge-coupled devices for white light endoscopy (WLE) and autofluorescence imaging (AFT). Nondysplastic BE appears green on AFT, whereas potentially neoplastic areas appear blue/violet. The BE was first screened with WLE for visible abnormalities and then was examined by AFT to detect additional lesions. Lesions that raised a suspicion of neoplasia and control areas that were normal on AFT were sampled for histopathologic assessment. Finally, random 4-quadrant biopsy specimens were obtained at 2-cm intervals. Results: A diagnosis of HGD/EC was made in 22 patients; one patient had no visible abnormality, and 21 had endoscopically detectable areas with HGD/EC. In 6 of the latter 21 patients, the HGD/EC was detected with AFT alone; in another patient, HGD/EC was detected with AFT and random biopsies. In 14 patients, HGD/EC was detected with both WLE and AFT; in 3 of these 14 patients, additional lesions containing HGD/EC were detected by AFT alone. Conclusions: The results of this study suggest that video AFT may improve the detection of HGD/EC in patients with BE.