Optical imaging techniques, such as narrow–band imaging (NBI), are also being evaluated. NBI improves detection and delineation of certain lesions in Barrett’s esophagus by enhancing their abnormal surface and small vessel pattern relative to standard white–light endoscopy.

Laser confocal microscopy allows the microscopic imaging of the cell pattern. This gives the physician a real time view of individual cells, permitting differentiation across the continuum of normal to dysplasic to cancerous cells.

Laser confocal microscopy is particularly useful since it allows an immediate in–vivo diagnosis of dysplasia and /or cancer during real time endoscopy. It is a non–invasive technique that would decrease the number of random biopsies taken to establish a diagnosis of cancer or dysplasia. The better resolution of confocal laser microscopy compared to conventional light microscopy allows the endoscopist to better see subtle mucosal/submucosal irregularities which could be targeted for biopsies or endoscopic mucosal resection.

Auto–Fluorescence Imaging (AFI) may allow early cancer lesions to stand out better because they emit a different color (purple) from the non–cancer tissue (green) after shining the esophagus with blue light.

Endocystoscopy allows the physician to image tissue specimens at a cellular level to evaluate the details of microstructures in the specimen.

Fluorescent in situ hybridization (FISH) shows abnormalities in cells collected from the esophagus using fluroescent probes.

A new device, called near–infrared Raman spectroscopy, is being studied by Louis Wong Kee Song, M.D., to see if it can provide similar information as that obtained from taking biopsies of the lining of the Barrett's esophagus. Near–infrared Raman spectroscopy collects a form of light originating from the lining of the Barrett's esophagus, which has the potential of providing similar information as that obtained from taking biopsies of the esophagus lining.

The reason this is helpful is because using light would allow instant results, while taking biopsies will take at least a day to obtain results. If a physician can tell immediately if something is wrong with the lining of the esophagus, treatment can be given right away rather than waiting and requiring another procedure.