Magnifying Endoscopy in Combination with Narrow-Band Imaging and Acetic Acid Instillation in the Diagnosis of Barrett's Esophagus

Barrett's esophagus (BE) is a condition of the distal esophagus involving columnar-lined epithelium (CLE) with intestinal metaplasia (IM). During conventional endoscopy, IM in CLE is not clearly identifiable. Here we describe a technique of magnifying endoscopy (ME) using narrow-band imaging (NBI) in combination with acetic acid instillation in the diagnosis of BE. Within 10-20 s after acetic acid instillation, the mucosal surfaces whiten and fine mucosal Surface patterns become clearer with ME emphasized with NBI. We classified CLE surface patterns into five types: type I, small round pits of uniform size and shape; type II, slit-like pits; type III, gyrus and villous pattern; type IV, irregular size and arrangement; type V, destructive pattern. A significant correlation between type III pattern and the presence of IM was observed (sensitivity 88.5%, specificity 90.2%, and overall accuracy 90.0%). Most adenocarcinomas expressed type TV or type V patterns. ME in combination with NBI and acetic acid instillation seems to be useful for identifying IM and early adenocarcinomas in CLE.