Usefulness of magnifying endoscopy with narrow band imaging for the detection of specialized intestinal metaplasia in columnar-lined esophagus and Barrett's adenocarcinoma

Background: Barrett's esophagus with specialized intestinal metaplasia (SIM) from columnar-lined esophagus is difficult to distinguish with routine endoscopy. Objective: To examine the values of fine mucosal patterns and the capillary patterns observed by magnifying endoscopy with narrow band imaging (MENBI) for the detection of SIM in columnar-lined esophagus and superficial Barrett's adenocarcinoma. We also undertook a histologic investigation regarding whether the capillary pattern observed by MENBI corresponds to the 3-dimensional (3D) structure of the capillary as depicted by using a confocal laser-scanning microscope (CLSM). Design: To compare the findings of MENBI, at 217 sites of columnar-lined esophagus, with histologic findings. Capillaries of the superficial mucosal layer were observed and were analyzed by 3D with a CLSM in 45 biopsied specimens. Patients: Fifty-eight patients, including 4 with superficial Barrett's adenocarcinoma. Setting: Jikei University Hospital, Tokyo, Japan. Results: Upon observation, all 6 adenocarcinoma sites were classified as irregular patterns in both the fine mucosal patterns and capillary patterns. The most characteristic endoscopic patterns of SIM were revealed to be the cerebriform fine mucosal pattern (sensitivity, 56%; specificity, 79%; odds ratio, 4.78) and ivy- or deoxyribonucleic acid (DNA)-like capillary pattern (sensitivity, 77%; specificity, 94%; odds ratio, 51.6). The addition of capillary patterns to fine mucosal patterns improved the accuracy of diagnosing SIM (P < .0001). Conclusions: MENBI was able to precisely visualize the structure of capillaries in the superficial mucosal layer. The addition of capillary patterns to fine mucosal patterns appeared to improve the diagnostic value for detecting SIM and superficial Barrett's adenocarcinoma upon observation by MENBI.