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