Taking the Next Steps in Endoscopic Visual Assessment of Barrett’s Esophagus: A Pilot Study

Roxana Chis,1 Simon Hew,2 Wilma Hopman,3 Lawrence Hookey,2 Robert Bechara2 1Division of Internal Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, Ontario, Canada; 2Division of Gastroenterology, Kingston Health Sciences Centre, Queen’s University, Kingston General Hospital, Kingston, Ontario, Canada; 3Research Institute, Kingston Health Sciences Centre, Queen’s University, Kingston, Ontario, CanadaCorrespondence: Robert BecharaDivision of Gastroenterology, Queens University, Kingston Health Sciences Center, 166 Brock Street, Kingston, Ontario K7L1A8, CanadaTel + 613 544 3400Email bechara.robert@gmail.comPurpose: Patients with Barrett’s esophagus (BE) undergo surveillance endoscopies to assess for pre-cancerous changes. We developed a simple endoscopic classification method for predicting non-dysplastic BE (NDBE), low-grade dysplasia (LGD)/indefinite for dysplasia (ID) and high-grade dysplasia (HGD)/early esophageal adenocarcinoma (EAC).Patients and Methods: Twenty-two patients with BE underwent endoscopy using the PENTAX Medical MagniView gastroscope and OPTIVISTA processor. Sixty-six video-still images were analyzed to characterize the microsurface, microvasculature and the presence of a demarcation line. Class A was characterized by regular microvascular and microsurface patterns and absence of a demarcation line, class B by changes in the microvascular and/or microsurface patterns compared to the background mucosa with presence of a demarcation line, and class C by irregular microvascular and/or irregular microsurface patterns with presence of a demarcation line.Results: Of the class A images, 97.9% were NDBE. For class B, 69.2% were LGD/ID and 30.8% NDBE. One hundred percent of the class C samples were HGD/EAC. The sensitivity of our classification system was 93.8%, specificity 92%, positive predictive value 78.9%, negative predictive value 97.9% and an accuracy 92.4%.Conclusion: In this study, we developed a simple classification system for the prediction of NDBE, LGD/ID and HGD/EAC. Its real-time clinical applicability will be validated prospectively.Keywords: Barrett’s esophagus, BE, dysplasia, enhanced endoscopy, esophageal adenocarcinoma