Chromoendoscopy with Lugol's staining remains the gold standard technique for detecting superficial SCC. An alternative technique, such as narrow-band imaging (NBI), for “optical staining” would be desirable, since NBI is a simpler technique and has no known complications. In this study, we compare NBI without magnification and chromoendoscopy with Lugol's staining for detecting high-grade dysplasia and intramucosal esophageal squamous cell carcinoma (SCC) in patients with achalasia. This was a prospective observational study of 43 patients with achalasia referred to the Gastrointestinal Endoscopy Unit of the Hospital of Clinics, S？o Paulo, University Medical School, Brazil, from October 2006 to February 2007. Conventional examinations with white light, NBI, and Lugol staining were consecutively performed, and the suspected lesions were mapped, recorded, and sent for biopsy. The results of the three methods were compared regarding sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood value, and negative likelihood value. Of the 43 patients, one was diagnosed with esophageal squamous cell carcinoma, and it was detected by all of the methods. NBI technology without magnification has high sensitivity and negative predictive value for detecting superficial esophageal squamous cell carcinoma, and it has comparable results with those obtained with Lugol's staining. 1. Introduction Achalasia is a chronic esophageal motility disorder associated with esophageal retention of foods and fluids, bacterial overgrowth, and impaired clearance of regurgitated gastric contents [1]. These factors usually lead to chronic inflammation of the esophageal mucosa, which potentially increases the risk of hyperplasia, dysplasia, and esophageal cancer [2, 3]. Esophageal squamous cell carcinomas in achalasia patients have been investigated previously. In a large cohort followup study, Wychulis et al. [4] analyzed 1,318 patients and found a 7-fold increased risk of esophageal squamous cell carcinomas in achalasia patients compared to the general population. Despite some contradictory data [5–7], achalasia is generally accepted as a condition associated with an increased risk for developing esophageal squamous cell carcinoma [8, 9]. Chromoendoscopy with Lugol’s staining remains the gold standard technique for detecting superficial esophageal squamous cell carcinoma [10, 11]. Although Lugol’s staining is a simple and low-cost method, instillation of its solution may lead to complications, such as hypersensitivity to iodine,
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