Texture and Colour Enhancement Imaging (TXI) versus White Light Endoscopy for Detection of Dysplasia Within Barrett's Esophagus: a Pilot Study.

Introduction: Esophageal cancer is a leading global health issue, with increasing prevalence of esophageal adenocarcinoma and its precursor lesion, Barrett's esophagus (BE). Despite the opportunity to treat dysplasia prior to adenocarcinoma development, rates of missed advanced dysplasia at BE surveillance remain high. This pilot study aimed to assess whether Texture and Colour Enhancement Imaging (TXI), a new advanced mucosal imaging modality, improves dysplasia detection during BE surveillance compared to white light endoscopy (WLE).

Methods: Patients undergoing endoscopy for BE assessment or surveillance at a single centre were included for analysis. Patients were randomized in a 1:1 ratio to examination with WLE then TXI or vice versa, followed by Narrow-Band Imaging (NBI). Targeted biopsies were taken from any suspicious areas and 4-quadrant surveillance biopsies were taken at 1cm intervals in the entire BE segment.

Results: A total of 50 patients were included in the study, with 27 suspicious lesions seen in 22 patients. 93.3% (n=14/15) of high-grade dysplasia or early adenocarcinoma was detected as endoscopically visible lesions on TXI and NBI. However, 4 such lesions were not detected on WLE. On per-patient analysis, the sensitivity and NPV of TXI in combination with magnified NBI were both 100% with specificity of 84.6%, surpassing all PIVI thresholds for dysplasia diagnosis in BE.

Conclusion: This pilot study demonstrates the feasibility of TXI as a potential addition to the armamentarium of advanced mucosal imaging available to proceduralists surveilling Barrett's Esophagus. Further large multi-centre studies would be required to make statistical comparisons with existing imaging modalities.