BLUE LIGHT IMAGING FOR BARRETT'S NEOPLASIA CLASSIFICATION (BLINC): A NEW ENDOSCOPIC CLASSIFICATION IN BARRETT'S OESOPHAGUS

Aims:

Neoplasia in Barrett's can be subtle and difficult to identify. Blue light imaging (BLI) is a novel advanced endoscopic technology that provides high intensity contrast imaging for superior visualisation of mucosal surface and vessel patterns. This can improve the identification of Barrett's neoplasia. To date there is no formal classification system that enables the characterisation of neoplastic and non-neoplastic Barrett's for BLI. The aim of our study was to develop and validate a classification to identify Barrett's neoplasia using BLI.

Methods:

There were 3 phases to the study. In phase 1, 3 expert endoscopists identified descriptive component criteria pertaining to neoplastic and non-neoplastic Barrett's. Phase 2 involved the internal validation of these criteria by experienced endoscopists using 50 images to develop a classification system. In phase 3, general endoscopists were trained to use BLINC and subsequently characterised the same set of images. Sensitivity, specificity and negative predictive value (NPV) of neoplasia identification was measured.

Results:

Phase 1 and 2 led to the development of BLINC which utilised colour, pit and vessel pattern to characterise neoplastic and non-neoplastic Barrett's. It had a sensitivity, specificity and NPV of 96.7%, 96.7% and 95.9% when validated by experienced endoscopists. The table below shows the results of Phase 3.

Tab. 1:

Validation of BLINC among general endocopists

	At baseline (prior to training on BLINC)	Following training on BLINC	Significance
Sensitivity (95% confidence interval)	85.2 (78.1 – 90.7) %	96.8 (92.0 – 99.1) %	p = 0.001
Specificity (95% confidence interval)	85.2 (77.4 – 91.2)%	82.4 (74.6 – 88.6)%	p > 0.05
NPV (95% confidence interval)	83.1 (76.5 – 88.1) %	96.3 (90.7 – 98.6) %	p = 0.001

Conclusions:

We developed and validated a new classification system (BLINC) for the diagnosis of Barrett's neoplasia using BLI. BLINC has successfully improved the sensitivity and NPV for detection of Barrett's neoplasia and is a useful tool for training in optical diagnosis in this area.