Narrow band imaging for Barrett’s oesophagus

The technology described in this briefing is narrow band imaging (NBI). It is used for identifying neoplastic and dysplastic tissue during endoscopy in people with known or suspected Barrett's oesophagus.

The innovative aspects are that NBI provides real-time optical enhancement of the endoscopy procedure, allowing the endoscopist to identify areas for targeted biopsy.

The intended place in therapy would be as well as white-light endoscopy in people with Barrett's oesophagus either during initial diagnostic endoscopy or for surveillance of people with Barrett's oesophagus. It is intended to reduce or remove the need to take random biopsies.

The main points from the evidence summarised in this briefing are from 3 studies: 1 randomised crossover trial, 1 feasibility study and 1 report on the development and validation of diagnostic criteria for NBI, including a total of 1,185 adults and 330 images. They show that NBI is at least as effective as white-light endoscopy in people with Barrett's oesophagus and suspected dysplasia and neoplasia.

Key uncertainties around the evidence or technology are that current evidence for NBI was done in highly specialised centres, therefore it is unclear how generalisable this is to routine NHS practice.

The cost of NBI would be as well as standard care and is estimated by the company to be £1,120 per NBI endoscopy. The increased resource impact may be offset if there is a reduced need for histopathology testing.