Low-cost high-resolution microendoscopy for the detection of esophageal squamous cell neoplasia: An international trial

Background & Aims Esophageal squamous cell neoplasia has a high mortality rate as a result of late detection. In high-risk regions such as China, screening is performed by Lugol's chromoendoscopy (LCE). LCE has low specificity, resulting in unnecessary tissue biopsy with a subsequent increase in procedure cost and risk. The purpose of this study was to evaluate the accuracy of a novel, low-cost, high-resolution microendoscope (HRME) as an adjunct to LCE. Methods In this prospective trial, 147 consecutive high-risk patients were enrolled from 2 US and 2 Chinese tertiary centers. Three expert and 4 novice endoscopists performed white-light endoscopy followed by LCE and HRME. All optical images were compared with the gold standard of histopathology. Results By using a per-biopsy analysis, the sensitivity of LCE vs LCE + HRME was 96% vs 91% (P =.0832), specificity was 48% vs 88% (P <.001), positive predictive value was 22% vs 45% (P <.0001), negative predictive value was 98% vs 98% (P =.3551), and overall accuracy was 57% vs 90% (P <.001), respectively. By using a per-patient analysis, the sensitivity of LCE vs LCE + HRME was 100% vs 95% (P =.16), specificity was 29% vs 79% (P <.001), positive predictive value was 32% vs 60%, 100% vs 98%, and accuracy was 47% vs 83% (P <.001). With the use of HRME, 136 biopsies (60%; 95% confidence interval, 53%-66%) could have been spared, and 55 patients (48%; 95% confidence interval, 38%-57%) could have been spared any biopsy. Conclusions In this trial, HRME improved the accuracy of LCE for esophageal squamous cell neoplasia screening and surveillance. HRME may be a cost-effective optical biopsy adjunct to LCE, potentially reducing unnecessary biopsies and facilitating real-time decision making in globally underserved regions.