Narrow band imaging for Barrett’s oesophagus

Level of innovation

All specialists stated that narrow band imaging (NBI) is innovative (despite being first introduced to the NHS in 2006) and that it has not been superseded or replaced by other technologies. One specialist noted that the image produced by NBI is substantially different to images produced by other endoscopy methods, such as white-light endoscopy. Another specialist noted that NBI has inline filter manipulation, which differentiates it from other advanced endoscopy techniques and involves post-imaging manipulation.

One specialist noted that using NBI would need a novel protocol for optical assessment only without random biopsies.

Potential patient impact

All specialists suggested that if NBI allows earlier detection of dysplasia and early cancer, it could allow for earlier treatment and better health outcomes for patients. One specialist noted that if early neoplastic change is detected, radiofrequency ablation can be used to prevent any further changes to the tissue. Another specialist noted that use of NBI may lead to a slight reduction in endoscopy time because of fewer biopsy samples being collected.

All specialists noted that NBI is most useful in people with Barrett's oesophagus who have suspected dysplasia or unusual lesions. These people will have had a previous white-light endoscopy and will have been referred for further investigation at an endoscopy unit.

One specialist noted that if NBI reduces the number of biopsies needed it may be particularly beneficial to people who are not able to tolerate repeat biopsies, such as people on antithrombotic medication.

Potential system impact

Two specialists agreed that if NBI were used widely there would be a reduction in biopsies and associated costs. Earlier detection of cancer may also lead to reduced treatment costs. One specialist noted that NBI was likely to cost the same as white-light endoscopy and that there was not enough evidence to support a reduction in histopathology costs.

One specialist estimated that two-thirds of endoscopy units in the UK use an Olympus endoscope with NBI functionality, another estimated that around 80% of units had NBI available.

All specialists highlighted the need for training for endoscopists in how to use NBI and on how to implement visual assessment technique over random biopsy.

General comments

Most endoscopy units in the NHS will have equipment that is capable of using NBI, however, most endoscopists have not been trained or evaluated in their use of this technology.

The evidence for NBI shows that it can be used to improve detection of high-grade dysplasia, however there is no evidence to show that it can be used to detect low-grade dysplasia. If low-grade dysplasia is detected the patient may be referred for ablation treatment because there is evidence to show that this can help prevent the disease from progressing.

The evidence for NBI compares its use with standard definition white-light endoscopy, however, specialist commentators note that high-definition white-light endoscopy with targeted biopsy is used in some endoscopy units in the NHS.