Table 2:

Pros and Cons of Various Endoscopic Screening Methods

Endoscopic screening modalities	Pros	Cons	PIVI criteria for Squamous Dysplasia Reached?
All modalities	•Visualizes the mucosa	• Uncomfortable if not done with sedation (which is frequently not available in resource poor areas) • Requires operator training and experience • Expensive equipment	•
Conventional white light endoscopy	• Readily available in developed areas	• Lacks sensitivity for precursor lesions	• No
Chromoendoscopy	• Inexpensive • Improves sensitivity for precursor lesions/dysplasia • Short learning curve • Clarity of lesion borders	• Irritant/allergic reactions to iodine • Lower specificity for precursor lesions (before biopsy diagnosis)	• Yes
Endoscopy with Narrow Band Imaging	• Improves sensitivity and specificity for precursor lesions/dysplasia • Does not require iodine	• Increased cost of equipment • Longer learning curve • Requires more operator expertise	• Yes
Transnasal endoscopy	• No need for sedation • Improves cost effectiveness	• Currently not standard of care, not widely available • Lack of trained operators • Cannot be combined with Lugol’s or NBI to detect precursor lesions. • Not yet tested on precursor lesions • Smaller biopsies • No therapeutic capabilities • Increased risk for patients with ENT pathology	• Yes (only if combined with FICE)
Endocytoscopy	• Cellular level resolution may obviate need for some or all biopsies	• A contact probe technology • Small field of view • Can only be used with other lesion localization technologies (Lugol’s or NBI) • Increased cost of equipment • Additional training needed • Not yet tested on precursor lesions	• Yes
Microendoscopy	• Inexpensive and portable • Cellular level resolution may obviate need for some or all biopsies • Can be portable and added to standard endoscope • High sensitivity and specificity for dysplasia and early stage cancer.	• A contact probe technology • Small field of view • Can only be used with other lesion localization technologies (Lugol’s or NBI) • Additional training needed • Variable cost-effectiveness when compared to standard endoscopic screening techniques	• Yes