NBI and Acetic Acid Chromoendoscopy in Barrett’s Oesophagus: BMJ Open Gastroenterology | March 2026

Introduction

Barrett’s oesophagus represents a well-established precursor to oesophageal adenocarcinoma, with progression from intestinal metaplasia to dysplasia and invasive cancer. Given the poor prognosis of advanced disease, early detection through surveillance endoscopy remains critical. Conventional surveillance relies on high-definition white light endoscopy combined with the Seattle protocol of random biopsies, which is labour-intensive and prone to sampling error. Emerging advanced imaging modalities, particularly narrow band imaging (NBI) and acetic acid chromoendoscopy (AAC), aim to enhance dysplasia detection and enable more targeted biopsy strategies.

Problem Statement

Despite technological advances, current surveillance strategies remain inefficient, with random biopsies risking missed dysplasia and increasing procedural burden. The key challenge is whether advanced imaging techniques can reliably replace or reduce reliance on the Seattle protocol while maintaining diagnostic safety.

Summary

This systematic review of 44 studies demonstrates that NBI-guided biopsies improve overall dysplasia detection compared with white light endoscopy, while AAC offers higher sensitivity for neoplasia detection and reduces biopsy burden. However, neither technique alone is sufficient to replace the Seattle protocol due to the risk of missed lesions.

The findings support a hybrid approach, integrating advanced imaging with systematic biopsies, while emphasising the need for high-quality randomised trials to define cost-effectiveness and optimise surveillance strategies in Barrett’s oesophagus.