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The investigators hypothesize that careful examination of Barrett's esophagus by high-resolution endoscopy combined with virtual chromoendoscopy could replace the Seattle protocol for Barrett's esophagus monitoring and detection of dysplasic lesions, and thus modify existing recommendations.
Barrett's esophagus (BE) is a pre-neoplastic condition that predisposes to dysplasia and adenocarcinoma of the esophagus, a cancer with an increasing incidence and poor prognosis. However, when detected at an early stage, superficial lesions can be effectively treated by endoscopic resection. Although BE degeneration remains a rare event, the European Society for Gastrointestinal Endoscopy recommends that BE be followed according to its size. Follow-up consists of a digestive endoscopy with white light examination of the esophagus, targeted biopsies of any visible lesions and quadrantic biopsies every 2 centimeters from the esogastric junction to the top of the BE, at a frequency that depends on the presence of dysplasia and the size of the BE. However, physician adherence to this procedure, known as the Seattle Protocol, is low because : 1) it increases the time required for the endoscopist to examine the patient and therefore the duration of sedation, as well as the time needed to interpret the pathology, 2) the risk of sampling error is high because only a small portion of the esophageal mucosa can be biopsied and 3) this approach is costly because of the time spent on the Seattle protocol in the operating room and in the pathology department.
New optical tools such as high-resolution endoscopy combined with magnification and electronic chromoendoscopy can reveal subtle mucosal and microvascular changes in the BE, which could improve the detection of early neoplastic lesions. However, there is still insufficient evidence to recommend its use in routine BE surveillance.
The investigators hypothesize that careful examination of Barrett's Esophagus by high-resolution endoscopy combined with virtual chromoendoscopy could replace the Seattle protocol for BE monitoring and detection of dysplasic lesions, and thus modify existing recommendations.
In this study, each patient will be his(her) own control and have the two procedures :
Firstly, an endoscopist called A will perform high-resolution endoscopy combined with virtual chromoendocopy and note on a scheme the biopsies/resection he would have done with this procedure.
Secondly, another endoscopist called B will do the examination using white light modality of the endoscope and process as follows :
Final histology results will serve as gold standard for the diagnosis of early esophageal adenocarcnoma or high grade displasia.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Electronic chromoendoscopy | Experimental | High-resolution endoscopy combined with virtual chromoendocopy to detect esophageal displasic lesions |
|
| White light endoscopy with Seattle protocol | Active Comparator | White light endoscopy to detect esophageal displasic lesions, and then systemic quadrantic biopsies every 2 centimeters from the esogastric junction to the top of the Barett's esophagus (Seattle protocol) |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Electronic chromoendoscopy | Procedure | Inspection of the Barrett's esophagus using the electronic chromoendoscopy modality of the endoscope for the detection of high-grade dysplasia and adenocarcinoma lesions. |
| Measure | Description | Time Frame |
|---|---|---|
| Rate of both high grade dysplasia and esophageal adenocarcinoma lesions detected by electronic chromoendoscopy versus rate of such lesions detected by white light endoscopy plus systemic biopsies according to Seattle protocol. | Day 1 |
| Measure | Description | Time Frame |
|---|---|---|
| Rate of both high grade dysplasia and esophageal adenocarcinoma lesions detected by electronic chromoendoscopy versus rate of such lesions detected by white light endoscopy. | Day 1 | |
| Rate of low grade displasia lesions detected by electronic chromoendoscopy versus rate of such lesions detected by white light endoscopy plus systemic biopsies according to Seattle protocol. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Lucille QUENEHERVE, Doctor | CHU de Brest | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Amiens University Hospital | Amiens | 80054 | France | |||
| Besançon University Hospital |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 42420864 | Derived | Queneherve L, Hardouin JB, Riche VP, Compaore Y, Archambeaud I, Bardot S, Alebic IJ, Marguerite M, Letaillandier C, Ratajczak C, Pierry O, Jobert A, Rahmi G, Berger A, Karsenti D, Yzet C, Pioche M, Barrioz T, Tchoumak I, Schaefer M, Chevaux JB, Jacques J, Wallenhorst T, Vanbiervliet G, Koch S, Barret M, Poinas A, Coron E. Detection of high-grade dysplasia and adenocarcinoma in Barrett's esophagus using high-resolution virtual chromoendoscopy versus the Seattle protocol: the CONVERSE study. BMC Gastroenterol. 2026 Jul 8. doi: 10.1186/s12876-026-05038-3. Online ahead of print. |
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Each patient will be his (her) own control and have the two procedures :
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The two endoscopists will be blinded to each other's findings when searching the lesions.
| White light endoscopy with Seattle protocol | Procedure | Inspection of the Barrett's esophagus using the white light modality of the endoscope for the detection of high-grade dysplasia and adenocarcinoma lesions, and then systemic quadrantic biopsies every 2 centimeters from the esogastric junction to the top of the Barett's esophagus (Seattle protocol) |
|
| Day 1 |
| Duration (in minutes) of each procedure: white light endoscopy, electronic chromoendoscopy, Seattle protocol. | Day 1 |
| Rate of missed lesions (both high grade dysplasia and esophageal adenocarcinoma) diagnosed by an adjudication committee reviewing videos from the procedure. | Day 1 |
| Rate of resected lesions (both high grade dysplasia and esophageal adenocarcinoma) that were detected by endoscopist performing electronic chromoendoscopy, but missed by endoscopist performing white light endoscopy and Seattle protocol. | Day 1 |
| Number of adverse events | Day 30 |
| Cost effectiveness of the detection of both early esophageal adenocarcinoma and high grade dysplasia with electronic chromoendoscopy versus cost effectiveness of Seattle protocol. | Day 30 |
| Besançon |
| 25030 |
| France |
| Bordeaux University Hospital | Bordeaux | 33604 | France |
| Brest University Hospital | Brest | 26609 | France |
| Private Bercy clinic | Charenton | 94220 | France |
| Limoges University Hospital | Limoges | 87000 | France |
| Lyon University Hospital | Lyon | 69003 | France |
| Nancy University Hospital | Nancy | 54511 | France |
| Nantes University Hospital | Nantes | 44093 | France |
| Nice University Hospital | Nice | 06202 | France |
| Public Assistance - Paris hospitals - Cochin hospital | Paris | 75014 | France |
| Public Assistance- Paris Hospitals - Georges Pompidou European Hospital | Paris | 75015 | France |
| Poitiers University Hospital | Poitiers | 86021 | France |
| Rennes University Hospital | Rennes | 35033 | France |
| Sainte Barbe Clinic | Strasbourg | 67000 | France |
| ID | Term |
|---|---|
| D001471 | Barrett Esophagus |
| ID | Term |
|---|---|
| D011230 | Precancerous Conditions |
| D009369 | Neoplasms |
| D004935 | Esophageal Diseases |
| D005767 | Gastrointestinal Diseases |
| D004066 | Digestive System Diseases |
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