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Barrett's esophagus: Evaluation with narrow band imaging

Jacques J Bergman, MD, PhD
Section Editor
Nicholas J Talley, MD, PhD
Deputy Editor
Kristen M Robson, MD, MBA, FACG


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 [1]. 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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Literature review current through: Nov 2017. | This topic last updated: Jun 28, 2017.
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  1. Qumseya BJ, Wang H, Badie N, et al. Advanced imaging technologies increase detection of dysplasia and neoplasia in patients with Barrett's esophagus: a meta-analysis and systematic review. Clin Gastroenterol Hepatol 2013; 11:1562.
  2. Gono K, Obi T, Yamaguchi M, et al. Appearance of enhanced tissue features in narrow-band endoscopic imaging. J Biomed Opt 2004; 9:568.
  3. Machida H, Sano Y, Hamamoto Y, et al. Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study. Endoscopy 2004; 36:1094.
  4. Yoshida T, Inoue H, Usui S, et al. Narrow-band imaging system with magnifying endoscopy for superficial esophageal lesions. Gastrointest Endosc 2004; 59:288.
  5. Hamamoto Y, Endo T, Nosho K, et al. Usefulness of narrow-band imaging endoscopy for diagnosis of Barrett's esophagus. J Gastroenterol 2004; 39:14.
  6. Sharma P. Narrow band imaging in Barrett's esophagus. Clin Gastroenterol Hepatol 2005; 3:S21.
  7. Kara MA, Peters FP, Rosmolen WD, et al. High-resolution endoscopy plus chromoendoscopy or narrow-band imaging in Barrett's esophagus: a prospective randomized crossover study. Endoscopy 2005; 37:929.
  8. Goda K, Tajiri H, Ikegami M, et al. Usefulness of magnifying endoscopy with narrow band imaging for the detection of specialized intestinal metaplasia in columnar-lined esophagus and Barrett's adenocarcinoma. Gastrointest Endosc 2007; 65:36.
  9. Sharma P, Wani S, Bansal A, et al. A feasibility trial of narrow band imaging endoscopy in patients with gastroesophageal reflux disease. Gastroenterology 2007; 133:454.
  10. Fock KM, Teo EK, Ang TL, et al. The utility of narrow band imaging in improving the endoscopic diagnosis of gastroesophageal reflux disease. Clin Gastroenterol Hepatol 2009; 7:54.
  11. Sharma P, Hawes RH, Bansal A, et al. Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett's oesophagus: a prospective, international, randomised controlled trial. Gut 2013; 62:15.
  12. Kara MA, Ennahachi M, Fockens P, et al. Detection and classification of the mucosal and vascular patterns (mucosal morphology) in Barrett's esophagus by using narrow band imaging. Gastrointest Endosc 2006; 64:155.
  13. Sharma P, Weston AP, Topalovski M, et al. Magnification chromoendoscopy for the detection of intestinal metaplasia and dysplasia in Barrett's oesophagus. Gut 2003; 52:24.
  14. Sharma P, Bansal A, Mathur S, et al. The utility of a novel narrow band imaging endoscopy system in patients with Barrett's esophagus. Gastrointest Endosc 2006; 64:167.
  15. Anagnostopoulos GK, Yao K, Kaye P, et al. Novel endoscopic observation in Barrett's oesophagus using high resolution magnification endoscopy and narrow band imaging. Aliment Pharmacol Ther 2007; 26:501.
  16. Singh R, Anagnostopoulos GK, Yao K, et al. Narrow-band imaging with magnification in Barrett's esophagus: validation of a simplified grading system of mucosal morphology patterns against histology. Endoscopy 2008; 40:457.
  17. Wolfsen HC, Crook JE, Krishna M, et al. Prospective, controlled tandem endoscopy study of narrow band imaging for dysplasia detection in Barrett's Esophagus. Gastroenterology 2008; 135:24.
  18. Curvers WL, Bergman JJ. Multimodality imaging in Barrett's esophagus: looking longer, seeing better, and recognizing more. Gastroenterology 2008; 135:297.
  19. Curvers W, Baak L, Kiesslich R, et al. Chromoendoscopy and narrow-band imaging compared with high-resolution magnification endoscopy in Barrett's esophagus. Gastroenterology 2008; 134:670.
  20. Alvarez Herrero L, Curvers WL, Bansal A, et al. Zooming in on Barrett oesophagus using narrow-band imaging: an international observer agreement study. Eur J Gastroenterol Hepatol 2009; 21:1068.
  21. Curvers WL, Bohmer CJ, Mallant-Hent RC, et al. Mucosal morphology in Barrett's esophagus: interobserver agreement and role of narrow band imaging. Endoscopy 2008; 40:799.
  22. Silva FB, Dinis-Ribeiro M, Vieth M, et al. Endoscopic assessment and grading of Barrett's esophagus using magnification endoscopy and narrow-band imaging: accuracy and interobserver agreement of different classification systems (with videos). Gastrointest Endosc 2011; 73:7.
  23. Mannath J, Subramanian V, Hawkey CJ, Ragunath K. Narrow band imaging for characterization of high grade dysplasia and specialized intestinal metaplasia in Barrett's esophagus: a meta-analysis. Endoscopy 2010; 42:351.