Barrett's esophagus: Evaluation with narrow band imaging
- 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 Barrett's esophagus and surveillance for dysplasia and cancer. Many new endoscopic techniques continue to be developed including magnification endoscopy, chromoendoscopy, optical coherence tomography, confocal endomicroscopy, narrow band imaging, and autofluorescence endoscopy, but none is used routinely in clinical practice. (See "Magnification endoscopy" and "Chromoendoscopy" and "Optical coherence tomography in the gastrointestinal tract" and "Confocal laser endomicroscopy and endocytoscopy" and "Barrett's esophagus: Evaluation with autofluorescence endoscopy".)
This topic review will summarize the experience with narrow band imaging. General approaches to diagnosis and management of Barrett's esophagus are discussed separately (see "Barrett's esophagus: Epidemiology, clinical manifestations, and diagnosis" and "Barrett's esophagus: Surveillance and management"). Also see appropriate topic reviews for issues related to optical coherence tomography, autofluorescence and magnification endoscopy, and chromoendoscopy.
Narrow band imaging (NBI) is a high-resolution endoscopic technique that enhances the fine structure of the mucosal surface without the use of dyes (picture 1 and picture 2). NBI is based upon the phenomenon that the depth of light penetration depends on its wavelength; the longer the wavelength, the deeper the penetration. Blue light penetrates only superficially, whereas red light penetrates into deeper layers.
The first prototype NBI system (Olympus Corp, Tokyo, Japan) is based upon a light source with sequential red-green-and-blue (RGB) illumination. White light from a Xenon lamp is passed through a rotary RGB filter that separates the white light into the colors red, green, and blue, which are used to sequentially illuminate the mucosa. The red, green, and blue reflected light is detected separately by a monochromatic charged coupled device (CCD) placed at the tip of the endoscope, and the three images are integrated into a single color image by the video processor. In addition to the conventional RGB filters for white light endoscopy (WLE), the narrow band imaging system has special RGB filters of which the bandpass ranges have been narrowed and the relative contribution of blue light has been increased. This RGB-based NBI system is commercially available in Japan and the United Kingdom. In other parts of the world, the endoscopy systems are not based on RGB illumination but use white light illumination in combination with a color CCD-chip. NBI systems are commercially available for these endoscopy systems as well.
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