Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands.
Gastrointest Endosc. 2019 Apr;89(4):749-758. doi: 10.1016/j.gie.2018.10.046. Epub 2018 Nov 9.
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.
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 (visual analog scale scores); (2) ability to delineate lesions (visual analog scale scores); (3) preferred technique for delineation (ordinal scores); and (4) quantitative agreement on delineations (AND/OR scores).
Experts appreciated BLI significantly better than WLE for visualization of macroscopic appearance (median 8.0 vs 7.0, P < .001) and surface relief (8.0 vs 6.0, P < .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 < .001 and 8.0 vs 5.0, P < .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 = .015) and magnification (mean difference, 0.10; P = .01).
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. (ISRCTN registry study ID: ISRCTN15916689.).
巴雷特食管（BE）早期肿瘤的内镜特征较细微。蓝光成像（BLI）可能改善肿瘤病变的可视化效果。本研究旨在评估 BLI 在观察 BE 肿瘤中的作用。
前瞻性地获得 40 例 BE 病变的白光内镜（WLE）和 BLI 图像，并由 6 名国际专家进行 3 次评估。每次评估均包括全貌和放大图像。评估如下：评估 1，仅 WLE；评估 2，仅 BLI；评估 3，WLE 和 BLI 相应图像。评估参数如下：（1）宏观表现和表面隆起的评估（视觉模拟量表评分）；（2）病变的描绘能力（视觉模拟量表评分）；（3）首选描绘技术（等级评分）；（4）描绘的定量一致性（AND/OR 评分）。
与 WLE 相比，专家们认为 BLI 对宏观表现（中位数 8.0 比 7.0，P<0.001）和表面隆起（中位数 8.0 比 6.0，P<0.001）的可视化效果有明显改善。对于全貌和放大图像，专家们认为 BLI 对描绘病变的能力明显优于 WLE（8.0 比 6.0，P<0.001 和 8.0 比 5.0，P<0.001）。与 WLE 相比，WLE+BLI 的 AND/OR 评分无显著差异，但在 WLE 基线 AND/OR 评分较低的病例中，WLE+BLI 的一致性显著提高，全貌（平均差异 0.15；P=0.015）和放大（平均差异 0.10；P=0.01）。
BLI 对 BE 肿瘤的可视化具有附加价值。与 WLE 相比，专家们认为 BLI 对 BE 肿瘤的可视化和描绘更好。当 BLI 与 WLE 一起用于单独使用 WLE 难以描绘的病变时，定量一致性显著提高。（ISRCTN 注册表研究 ID：ISRCTN15916689。）
