Autofluorescence endoscopic surveillance and photodynamic treatment of Barrett's esophagus

Background. This study assessed the efficacy of autofluorescence endoscopy (AFE) using the Onco-LIFE system and numerical color value (NCV) estimation in comparison to white light endoscopy (WLE) in endoscopic surveillance for identification of early dysplasia in Barrett’s esophagus (BE). In the case of dysplasia photodynamic treatment (PDT) was carried out. Methods. AFE, performed simultaneously during WLE, with biopsy was performed in 24 patients with BE. None of these patients had any obvious mucosal abnormalities in WLE. A total of 376 biopsies were taken, include 325 randomly collected according to Seattle Protocol (SP) and 51 additional biopsies, taken from the sites with pathological AF and NCV, and then compared to histological examinations. The PDT was performed using 5-aminolevulinic acid (ALA) and DIOMED 630nm light source. Results. In the case of 248 biopsies taken from sites with NCV below 1.0, two cases of unspecified dysplasia were recognized; in 14 biopsies with NCV above 2.0 in all cases the various grades of dysplasia were documented. Dysplasia was found in 42% of AFE+NCV- guided biopsy specimens, and in 7.1% of WLE-guided biopsy specimens. AFE+NCV detected high-grade dysplasia in 7 patients, 6 more than according to SP in WLE. In the group patients with dysplasia, PDT was successfully carried out. Conclusion: The results indicate that AFE+NCV using the Onco-LIFE system leads to improved BE lesion visualization for targeted biopsy with accurate histologic correlation compared to WLE and SP guided biopsy, and can serve to minimize additional biopsies. PDT is an effective therapeutic method in BE.