Reimagining HRME's Global Role: Operator Expertise Gap Undermines Cost-Effective ESCN Screening
The recent randomized controlled trial by Tan et al1 presents compelling data on high-resonance microendoscopy (HRME)–enhanced Lugol’s chromoendoscopy (LCE) for esophageal squamous cell neoplasia (ESCN) detection. While the reported 2.6-fold diagnostic yield improvement is noteworthy, the study’s assertion of HRME’s applicability in resource-limited settings warrants critical examination — particularly given the chasm between expert and novice operator performance. Experts achieved 100% specificity with HRME, whereas novices showed no improvement (36% to 17% in surveillance), raising concerns about real-world scalability in regions reliant on non-specialists.
