Evolving screening and surveillance techniques for Barrett's esophagus

Table 6 Screening techniques for Barrett's esophagus[7]

	Advantage	Disadvantage
Standard definition white light endoscopy	Provides wide-field imaging and is widely available	Decreased sensitivity when compared to high definition
High definition white light endoscopy	Provides wide-field imaging and is widely available with improved image quality	Cost of procedure, sedation and in some cases updating entire endoscopy system. Some concerns over missed rates of dysplastic lesions
Dye-based chromoendoscopy	Provides wide-field imaging with benefit of mucosal enhancement	Additional steps in procedure are time consuming and some concerns over harm of contrast
Narrow band imaging	Provides wide-field imaging and is widely available with improved sensitivity and without need for contrast. Relatively cheap.	Still requires white light endoscopy as an adjunct with unclear evidence on its benefits when compared to white light endoscopy alone
Flexible intelligent chromoendoscopy and i-SCAN	Provides wide field imaging without the need for contrast	Not widely available and not enough research to determine benefits compared to standard of car
Blue light imaging	Helpful in defining subtle changes in elevation and depression of the mucosa	Beneficial as an adjunct to WLE only and hence requires similar costs. Not widely available.
Auto flourescence imaging	Provides wide field imaging with improved sensitivity and without the need for contrast	Poor specificity with high false positive rate.
Confocal laser endomicroscopy	Provides in vivo information, has a validated scoring classification, and can be used with any endoscope	Does not provide wide-field imaging, requires fluorescein prolonging procedure time, requires expert interpretation and expensive
Endocytoscopy	Increases ability to identify dysplastic and neoplastic lesions	Does not provide wide-field imaging and requires giving contrast agent
Optical coherence tomography	Provides in vivo information without need for contrast or fluorescein. Ability to evaluate subsurface	Does not provide wide-field imaging and research has varied and is ongoing
Volumetric laser endomicroscopy	Similar to OCT but provides high resolution, high speed images over wider surface area	Expensive and studies are still working to obtain interobserver agreement and correlating images with histology
Tethered capsule endomicroscopy	Utilizes same technology used for OCT and is safe, well tolerated by patients	Early in stages of research
Spectroscopy	Early studies have shown good success in real time detection of BE and neoplasia	Early in stages of research
wide area transepithelial sampling	Provides wide area sampling of tissue with high sensitivity and specificity and easy to use	Not yet widely available? Regarding cost and more research needed
Cytosponge	Generally safe and well tolerated with low cost	Still requires endoscopy for treatment if abnormality is identified
Transnasal Endoscopy	Generally safe and well tolerated with relatively lower cost than endoscopy without the need for general sedation. Can be used in clinic as well as hospital	While early studies have shown equivocal ability to diagnosis BE compared to conventional endoscopy, more research required
Biomarker panels	Early studies have shown ability to predict progression of BE from non-dysplastic to neoplasia	A single, ideal biomarker has not been delineated and more research is required.
Breath testing with an electronic nose device	Safe and well tolerated and easy to use with overall cost-effectiveness	Sensitivity and specificity are good but not great compared to some other methods and research at this point is limited

WLE: White light endoscopy; OCT: Optical coherence tomography; BE: Barrett's esophagus.