Advanced imaging (narrow band and acetic acid chromoendoscopy) and guided biopsies in surveillance of Barrett’s oesophagus: a systematic review

Abstract

ObjectivesTo systematically synthesise the evidence behind the use of narrow band imaging (NBI) and acetic acid chromoendoscopy (AAC) in Barrett’s oesophagus (BO) surveillance.DesignThe exploration phase followed the conceptual frameworks of Arksey and O’Malley and Levac et al for scoping reviews, and subsequently evolved into a systematic review that followed Joanna Briggs Institute (JBI) methodological guidance for conduct and Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines for reporting.Data sourcesPubMed, Medline, Scopus, Web of Science, Embase, CINHAL, Gray literature (GreyNet and OpenGrey) and reference reading.Eligibility criteriaPeer-reviewed full publications on interventional studies and cohort studies reporting effectiveness of NBI or AAC used for BO surveillance were included. Database searches were performed without restrictions on date of publication, up to the search period (December 2024–January 2025). Other observational studies, abstracts and non-English publications were excluded.Data extraction and synthesisData extraction and synthesis was performed by two reviewers using Covidence. The data were synthesised narratively and evaluated for quality of evidence.ResultsInitial search produced 974 articles. After excluding duplicates (389), ineligible articles (526) and abstract-only publications (15), 44 articles were selected for inclusion. Results indicated that NBI-targeted biopsies are more effective in overall dysplasia detection than white light endoscopy (WLE). While NBI and AAC are both effective in BO diagnosis with a smaller number of biopsies, AAC demonstrated a higher sensitivity for neoplasia detection than WLE. However, neither NBI-guided nor AAC-guided biopsy was able to replace Seattle protocol.ConclusionNBI provides higher dysplasia detection and AAC has a higher sensitivity, but neither can safely replace Seattle protocol biopsies.