A comparison of different endoscopic modalities for the detection of dysplasia and early cancer in patients with Barrett's Oesophagus undergoing surveillance endoscopy.

Narrow Band Imaging (NBI) with dual focus magnification are endoscopic imaging technologies which can be utilized with a switch of a button on the endoscope. Images can then be obtained which may enable better visualization of the Barrett’s segment. These are non invasive technologies where the light at the end of the endoscope changes to a more ‘narrow wave length light’ which could improve visualization of vasculature which can be more pronounced in early neoplasia. Patient’s will either receive the white light endoscopy (WLE) examination followed by examination with NBI or examination with the NBI followed by WLE. Any suspicious areas detected by both modalities will be documented (location and distance from incisors) and subsequently further assessed with Narrow Band Imaging with Dual Focus (NBI-DF) where ‘optical biopsies’/ interpretation of the histology will be made in real time. Targeted biopsies will then be taken. This will then be followed by random 4 quadrant biopsies on WLE. The time taken to perform the examination on NBI and NBI-DF as well as time taken to perform the examination on WLE will be documented. All images with all modalities will be recorded and stored in high definition files. All biopsies corresponding to the imaged areas on all modalities will be documented, labeled separately and sent for blinded histopathological examination. The addition of Narrow Band Imaging and dual focus magnification (to white light endoscopy) may increase the procedure time by up to 5 minutes in addition to the standard of care (see below comparetor/control treatment). The number of times that the test will be undertaken by the patient, will be only once at the baseline procedure.