Fluorescence Imaging for the Detection of Early Neoplasia in Barrett’s Esophagus; Old Looks

Early neoplasia arising from Barrett’s esophagus is often small, focally distributed and endoscopically poorly visible, and random four-quandrant biopsies may easily miss early lesions. Advanced imaging techniques, such as (auto)fluorescence based modalities, aim to increase the detection rate of early lesions or the yield of random biopsies. Fluorescence based light-tissue interaction has been successfully designed in point-probe differentiating spectroscopy systems or integrated into wide-field endoscopic systems such as autofluorescence imaging (AFI). In this review, we discuss the most recent advances in fluorescence spectroscopy and imaging for detecting early Barrett’s neoplasia. A spectroscopy probe, integrated into a regular biopsy forceps, was shown to offer decent discriminatory capabilities, while ensuring spot-on correlation between the measured area and the corresponding histology. With this tool, surveillance endoscopy with random biopsies may become more efficient and sensitive. AFI was shown to increase the targeted detection of early neoplasia. However, random biopsies could compensate for this effect. The clinical impact of AFI on the diagnosis and treatment of early neoplasia is limited, yet AFI may offer a novel approach in biomarker-based riskstratification models. Moreover, in combination with new, readily available contrast agents such as fluorescent lectins, fluorescence imaging may receive renewed interest.