The Role of Acetic Acid Chromoendoscopy and Narrow Band Imaging in Diagnosis of Esophageal Barrett Dysplasia

Abstract

Background: Barrett’s esophagus (BE) is an important risk factor for the occurrence esophageal adenocarcinoma. Endoscopic surveillance for Barrett’s dysplasia is indicated in all patients with BE. Recent data found that with the use of advanced endoscopic techniques there is an increased diagnostic yield for dysplasia. Aim: The aim of this study is to assess the accuracy of acetic acid assisted narrow band imaging (AA-NBI) endoscopy in detection of Barrett’s dysplasia. Patients and Methods: Forty patients with BE surveyed for Barrett’s dysplasia by AANBI endoscopy. Patients with difficult sampling (n=1) or not proved to have Barrett’s mucosa by histopathology (n=5) were excluded. Patients with positive and negative dysplasia underwent targeted and random endoscopic biopsy, respectively. The diagnosis of BE based on Prague endoscopic classification. The pathological assessment of Barrett’s dysplasia based on Vienna classification. Results: A total of 34 patients were included; their mean age was 39.03±14.23 years; they were 19 (55.88%) males and 15 (44.11%) females. Of them 28 (82.35%) had cardiac type BE, 3 (8.82%) had fundic type BE and 3 (8.82%) had intestinal type BE. Five patients were depicted as Barrett’s dysplasia by AA-NBI. Low grade dysplasia was proved in 3 of them by histopathology. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of AA-NBI in diagnosis of Barrett’s dysplasia were 100%, 93.5%, 60%, 100%, and 94.1% respectively. Conclusion: Nine percent of patients with BE are positive for dysplasia. AA-NBI has promising sensitivity, specificity and accuracy in prediction of Barrett’s dysplasia.