Endoscopic procedure

Patients received two endoscopy procedures during the trial period. In the standard arm, patients underwent HRWLE with diagnostic biopsies according to the gold standard (Seattle protocol). Briefly, the endoscopists were asked to perform a complete upper GI endoscopy with intubation to the second part of the duodenum, full photo documentation, and clinically indicated biopsy of non-esophageal lesions. Procedures were performed with FQ260Z, HQ290, or H290Z endoscopes (Olympus, Tokyo, Japan). For BE inspection, the BE mucosa was first inspected throughout the length of the BE segment. The presence of subtle lesions was not an exclusion criterion for the study; subtle lesions were defined as flat (Paris 0-IIb) lesions on non-magnified HRWLE, which were not judged by the endoscopist as obviously in keeping with BE neoplasia. These lesions received two targeted biopsies to minimize sampling error directed by HRWLE only. After inspection and targeted biopsies, random biopsies were taken at every 2 cm along the BE length. Endoscopists performing procedures within the standard arm were not allowed to use image-enhanced techniques, such as narrow-band imaging or acetic-acid chromoendoscopy. In the experimental arm, esophageal mucosa was inspected using HRWLE, followed by autofluorescence imaging and probe-based confocal laser endomicroscopy. At least two biopsies were taken from areas that were positive on autofluorescence imaging or had subtle changes on HRWLE. The full experimental protocol and data have been described previously
