Novel endoscopic observation in Barrett's oesophagus using high resolution magnification endoscopy and narrow band imaging

Background High resolution magnification endoscopy with narrow band imaging (NBI) may improve the detection of specialised intestinal metaplasia (SIM) and dysplasia in Barrett's oesophagus. Aims To describe the magnified endoscopic features with the use of NBI in Barrett's oesophagus. Methods Three hundred and forty-four areas from 50 patients with Barrett's oesophagus were studied using high resolution magnification endoscopy (HRME) with NBI and targeted biopsies were obtained. The sensitivity, specificity, predictive values of the various patterns for the prediction of SIM and dysplasia were calculated. Results The magnified endoscopic features of Barrett's oesophagus with the use of NBI consist of microstructural/microvascular patterns. The yield of SIM according to the patterns was: (i) Regular microstructural pattern with tubular/linear/villous pattern 90.6% and with circular pattern 0%; and (ii) Absent microstructural pattern 98.9%. The sensitivity, specificity, positive and negative predictive values of the combination of regular microstructural pattern (tubular/villous/linear) and absent microstructural pattern to detect SIM were 100%, 78.8%, 93.5% and 100%, respectively. The sensitivity, specificity, positive and negative predictive values of the irregular microvascular/microstructural pattern for the prediction of high grade dysplasia were 90%, 100%, 99.2% and 100%, respectively. Conclusion High resolution magnification endoscopy with NBI allows clear visualisation of microstructural and microvascular patterns within Barrett's oesophagus, and allows targeted biopsy with a high yield of SIM and high grade dysplasia.