A tandem trial of HD-NBI versus HD-WL to compare neoplasia miss rates in esophageal squamous cell carcinoma.

To determine whether the use of narrow-band imaging (NBI) system could enhance the detection rate of esophageal squamous cell carcinoma and precancerous lesions during endoscopic examination of the esophagus.113 patients were randomized to undergo endoscopic examination using high definition television (HDTV) narrow band imaging (NBI) endoscopy or HDTV WL endoscopy. The primary endpoint was the difference in the neoplasm miss rate, and secondary outcome was the neoplasm detection rate.The number of esophageal cancer and high grade intraepithelial neoplasia lesions detected by HD-NBI and HD-WL was 45 and 21, respectively. The neoplasm miss rate per lesion and per patient with HD-NBI showed significant difference compared with that of HD-WL (P <0.05). Characteristics of lesions missed by use of HD-NBI were similar to those missed by use of HD-WL; all missed lesions were high grade intraepithelial neoplasia lesions. Significant difference was observed between NBI and WL in adenoma detection rate (70.2% vs. 35.7%, P < 0.01).Endoscopy with HD-NBI seems to improve the detection of esophageal cancer and precancerous lesions, high definition may be tested for its effect on detection of esophageal cancer and precancerous lesions in the future. These results indicate that endoscopy routinely using the NBI system for the surveillance of esophageal cancer and precancerous lesions may be recommended.