Identification of predictive factors for early neoplasia in Barrett's esophagus after autofluorescence imaging: a stepwise multicenter structured assessment

Background: Autofluorescence imaging is a novel imaging technique that may improve the detection of early neoplasia in Barrett's esophagus. Autofluorescence imaging is, however, associated with a 40% to 81% false-positive rate. Objective: Our purpose was to identify endoscopic features that may predict the presence of early neoplasia in autofluorescence-positive areas. Design: Descriptive and prospective cohort study. Setting: Tertiary referral centers for the detection and treatment of early Barrett's neoplasia. Patients and Methods: Patients undergoing autofluorescence endoscopy. High-quality images with autofluorescence imaging and white-light endoscopy were obtained with corresponding histologic study. A systematic image evaluation process was performed, including an unblinded orientation phase (10 areas), a blinded derivation phase, and a blinded validation phase by 5 international experts in autofluorescence imaging (80 areas). Subsequently the identified features were validated in a prospective pilot study. Main Outcome Measurements: Association between endoscopic features and presence of early neoplasia in autofluorescence-positive areas. Results: Autofluorescence intensity, proximity of gastric folds <1 cm, and different appearance on white-light endoscopy were independently associated with early neoplasia in autofluorescence-positive areas on multivariate analysis. The κ values for interobserver agreement of these factors were moderate, ranging between 0.49 to 0.56. The association with autofluorescence intensity and different appearance on white-light endoscopy was confirmed in a prospective pilot study. Limitation: Selected set of images from a high-risk population (tertiary referral center). Conclusion: We found specific endoscopic features that were associated with early neoplasia in autofluorescence-positive areas. These findings can be used in future prospective studies to improve the accuracy of autofluorescence imaging without performing magnification endoscopy for detailed inspection of suspicious areas.