Endoscopy 2006; 38(9): 867-872
DOI: 10.1055/s-2006-944726
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Autofluorescence endoscopy in surveillance of Barrett’s esophagus: a multicenter randomized trial on diagnostic efficacy

J.  Borovicka1 , J.  Fischer2 , J.  Neuweiler3 , P.  Netzer4 , J.  Gschossmann4 , T.  Ehmann5 , P.  Bauerfeind6 , G.  Dorta5 , U.  Zürcher1 , J.  Binek1 , C.  Meyenberger1
  • 1Division of Gastroenterology/Hepatology, Dept. of Internal Medicine, Cantonal Hospital, St. Gallen, Switzerland
  • 2Dept. of Public Health, Social and Preventive Medicine, Mannheim Medical School, Heidelberg University, Germany
  • 3Institute of Pathology, St. Gallen, Switzerland
  • 4Division of Gastroenterology, University Hospital, Berne, Switzerland
  • 5Division of Gastroenterology, University Hospital, Lausanne, Switzerland
  • 6Division of Gastroenterology, University Hospital, Zurich, Switzerland
Further Information

Publication History

Submitted 19 January 2006

Accepted after revision 6 June 2006

Publication Date:
18 September 2006 (online)

Background and study aims: The reference surveillance method in patients with Barrett’s esophagus is careful endoscopic observation, with targeted as well as random four-quadrant biopsies. Autofluorescence endoscopy (AFE) may make it easier to locate neoplasia. The aim of this study was to elucidate the diagnostic accuracy of surveillance with AFE-guided plus four-quadrant biopsies in comparison with the conventional approach.
Patients and methods: A total of 187 of 200 consecutive Barrett’s esophagus patients who were initially enrolled (73 % male, mean age 67 years, mean Barrett’s segment length 4.6 cm), who underwent endoscopy for Barrett’s esophagus in four study centers, were randomly assigned to undergo either AFE-targeted biopsy followed by four-quadrant biopsies or conventional endoscopic surveillance, also including four-quadrant biopsies (study phase 1). After exclusion of patients with early cancer or high-grade dysplasia, who underwent endoscopic or surgical treatment, as well as those who declined to participate in phase 2 of the study, 130 patients remained. These patients were examined again with the alternative method after a mean of 10 weeks, using the same methods described. The main study parameter was the detection of early cancer/adenocarcinoma or high-grade dysplasia (HGD), comparing both approaches in study phase 1; the secondary study aim in phase 2 was to assess the additional value of the AFE-guided approach after conventional surveillance, and vice versa. Test accuracy measures were derived from study phase 1.
Results: In study phase 1, the AFE and conventional approaches yielded adenocarcinoma/HGD rates of 12 % and 5.3 %, respectively, on a per-patient basis. With AFE, four previously unrecognized adenocarcinoma/HGD lesions were identified (4.3 % of the patients); with the conventional approach, one new lesion (1.1 %) was identified. Of the 19 adenocarcinoma/HGD lesions detected during AFE endoscopy in study phase 1, eight were visualized, while 11 were only detected using untargeted four-quadrant biopsies (sensitivity 42 %). Of the 766 biopsies classified at histology as being nonneoplastic, 58 appeared suspicious (specificity 92 %, positive predictive value 12 %, negative predictive value 98.5 %). In study phase 2, AFE detected two further lesions in addition to the initial alternative approach in 3.2 % of cases, in comparison with one lesion with conventional endoscopy (1.7 %).
Conclusions: In this referral Barrett’s esophagus population with a higher prevalence of neoplastic lesions, the AFE-guided approach improved the diagnostic yield for neoplasia in comparison with the conventional approach using four-quadrant biopsies. However, AFE alone was not suitable for replacing the standard four-quadrant biopsy protocol.

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J. Borovicka, M. D.

Division of Gastroenterology/Hepatology · Dept. of Internal Medicine · Cantonal Hospital

9007 St. Gallen · Switzerland

Fax: +41-71-494-2862

Email: jan.borovicka@kssg.ch