Barrett's esophagus: Evaluation with autofluorescence endoscopy
- Jacques J Bergman, MD, PhD
Jacques J Bergman, MD, PhD
- Professor of Gastrointestinal Endoscopy
- Head of Endoscopy
- Department of Gastroenterology and Hepatology
- Academic Medical Center Amsterdam
Barrett's esophagus (BE) is the most important risk factor for esophageal adenocarcinoma, the incidence of which has been rising rapidly over the past few decades. Standard endoscopic imaging provides little detail of the mucosal surface, making it impossible to distinguish specialized intestinal epithelium from gastric-type metaplasia or to recognize dysplastic epithelium.
Better imaging modalities have the potential to improve detection of BE and surveillance for dysplasia and cancer. Many new endoscopic techniques continue to be developed including magnification endoscopy, chromoendoscopy, optical coherence tomography, narrow band imaging, and autofluorescence endoscopy, but none is used routinely in clinical practice.
This topic review will summarize experience with autofluorescence endoscopy. General approaches to diagnosis and management of BE are discussed separately. (See "Barrett's esophagus: Epidemiology, clinical manifestations, and diagnosis" and "Barrett's esophagus: Surveillance and management".)
LIGHT-TISSUE INTERACTION AND AUTOFLUORESCENCE
Several interactions are possible when a photon of light (excitation light) comes into contact with tissue:
●The photon may be reflected immediately.
- Kara M, DaCosta RS, Wilson BC, et al. Autofluorescence-based detection of early neoplasia in patients with Barrett's esophagus. Dig Dis 2004; 22:134.
- Dacosta RS, Wilson BC, Marcon NE. New optical technologies for earlier endoscopic diagnosis of premalignant gastrointestinal lesions. J Gastroenterol Hepatol 2002; 17 Suppl:S85.
- Kara MA, Dacosta RS, Streutker CJ, et al. Characterization of Tissue Autofluorescence (AF) In Non-dysplastic (NDBE) And Dysplastic Barrett Esophagus (BE) By Confocal Fluorescence Microscopy (CFM) (abstract). Gastroenterology 2004; 126:A50.
- Curvers WL, Singh R, Wallace MB, et al. Identification of predictive factors for early neoplasia in Barrett's esophagus after autofluorescence imaging: a stepwise multicenter structured assessment. Gastrointest Endosc 2009; 70:9.
- Vo-Dinh T, Panjehpour M, Overholt BF. Laser-induced fluorescence for esophageal cancer and dysplasia diagnosis. Ann N Y Acad Sci 1998; 838:116.
- Georgakoudi I, Jacobson BC, Van Dam J, et al. Fluorescence, reflectance, and light-scattering spectroscopy for evaluating dysplasia in patients with Barrett's esophagus. Gastroenterology 2001; 120:1620.
- Bourg-Heckly G, Blais J, Padilla JJ, et al. Endoscopic ultraviolet-induced autofluorescence spectroscopy of the esophagus: tissue characterization and potential for early cancer diagnosis. Endoscopy 2000; 32:756.
- Panjehpour M, Overholt BF, Vo-Dinh T, et al. Endoscopic fluorescence detection of high-grade dysplasia in Barrett's esophagus. Gastroenterology 1996; 111:93.
- Holz JA, Boerwinkel DF, Meijer SL, et al. Optimized endoscopic autofluorescence spectroscopy for the identification of premalignant lesions in Barrett's oesophagus. Eur J Gastroenterol Hepatol 2013; 25:1442.
- Boerwinkel DF, Holz JA, Hawkins DM, et al. Fluorescence spectroscopy incorporated in an Optical Biopsy System for the detection of early neoplasia in Barrett's esophagus. Dis Esophagus 2015; 28:345.
- Haringsma J, Tytgat GN, Yano H, et al. Autofluorescence endoscopy: feasibility of detection of GI neoplasms unapparent to white light endoscopy with an evolving technology. Gastrointest Endosc 2001; 53:642.
- Wong Kee Song LM, Marcon NE. Fluorescence and Raman spectroscopy. Gastrointest Endosc Clin N Am 2003; 13:279.
- Egger K, Werner M, Meining A, et al. Biopsy surveillance is still necessary in patients with Barrett's oesophagus despite new endoscopic imaging techniques. Gut 2003; 52:18.
- Kara MA, Smits ME, Rosmolen WD, et al. A randomized crossover study comparing light-induced fluorescence endoscopy with standard videoendoscopy for the detection of early neoplasia in Barrett's esophagus. Gastrointest Endosc 2005; 61:671.
- Borovicka J, Fischer J, Neuweiler J, et al. Autofluorescence endoscopy in surveillance of Barrett's esophagus: a multicenter randomized trial on diagnostic efficacy. Endoscopy 2006; 38:867.
- Kara MA, Peters FP, Ten Kate FJ, et al. Endoscopic video autofluorescence imaging may improve the detection of early neoplasia in patients with Barrett's esophagus. Gastrointest Endosc 2005; 61:679.
- Kara MA, Peters FP, Fockens P, et al. Endoscopic video-autofluorescence imaging followed by narrow band imaging for detecting early neoplasia in Barrett's esophagus. Gastrointest Endosc 2006; 64:176.
- Giacchino M, Bansal A, Kim RE, et al. Clinical utility and interobserver agreement of autofluorescence imaging and magnification narrow-band imaging for the evaluation of Barrett's esophagus: a prospective tandem study. Gastrointest Endosc 2013; 77:711.
- Curvers WL, Singh R, Song LM, et al. Endoscopic tri-modal imaging for detection of early neoplasia in Barrett's oesophagus: a multi-centre feasibility study using high-resolution endoscopy, autofluorescence imaging and narrow band imaging incorporated in one endoscopy system. Gut 2008; 57:167.
- Curvers WL, Alvarez Herrero L, Wallace MB, et al. Endoscopic tri-modal imaging is more effective than standard endoscopy in identifying early-stage neoplasia in Barrett's esophagus. Gastroenterology 2010; 139:1106.
- Curvers WL, van Vilsteren FG, Baak LC, et al. Endoscopic trimodal imaging versus standard video endoscopy for detection of early Barrett's neoplasia: a multicenter, randomized, crossover study in general practice. Gastrointest Endosc 2011; 73:195.
- Boerwinkel DF, Holz JA, Aalders MC, et al. Third-generation autofluorescence endoscopy for the detection of early neoplasia in Barrett's esophagus: a pilot study. Dis Esophagus 2014; 27:276.
- Mannath J, Subramanian V, Telakis E, et al. An inter-observer agreement study of autofluorescence endoscopy in Barrett's esophagus among expert and non-expert endoscopists. Dig Dis Sci 2013; 58:465.
- Boerwinkel DF, Holz JA, Kara MA, et al. Effects of autofluorescence imaging on detection and treatment of early neoplasia in patients with Barrett's esophagus. Clin Gastroenterol Hepatol 2014; 12:774.
- LIGHT-TISSUE INTERACTION AND AUTOFLUORESCENCE
- Autofluorescence for distinguishing tissue types
- AUTOFLUORESCENCE SPECTROSCOPY AND ENDOSCOPY
- Light-induced fluorescence spectroscopy
- Autofluorescence endoscopy
- - Fiberoptic fluorescence endoscopy
- - Video autofluorescence imaging
- INFORMATION FOR PATIENTS