Evaluation of narrow-band imaging signs in eosinophilic and lymphocytic esophagitis

Abstract

No specific endoscopic signs for diagnosing eosinophilic esophagitis (EoE) have been described and very few studies have reported endoscopic signs for lymphocytic esophagitis (LyE). This study aimed to assess the utility of narrow-band imaging magnifying endoscopy (NBI-ME) in predicting EoE/LyE diagnosis before histopathological assessment. Adult patients with dysphagia and/or food impaction who underwent esophagogastroduodenoscopy followed by NBI-ME and biopsies were included. Three previously reported NBI-ME signs were studied: beige mucosa, dot-shaped intra-epithelial papillary capillary loop (IPCL), and absent cyan vessels. These signs were compared with the histological diagnosis, and studied in patients with and without EoE or LyE. A predictive model containing the NBI-ME signs was analyzed, based on area under the curve (AUC). A total of 137 patients were enrolled. Based on histology 26 were diagnosed with EoE, 26 with LyE, and 85 were control patients with neither diagnosis. Significantly more EoE/LyE patients than control patients showed the NBI signs ( < 0.001 for all three signs). Absent cyan vessels had the highest accuracy for differentiation (sensitivity 88 %, specificity 92 %). A combination of age, dot IPCLs, and absent cyan vessels was highly predictive of EoE/LyE, with an AUC of 0.952. Three NBI-ME signs were found in the majority of patients with EoE/LyE and unlikely to be observed in controls. A combination of two NBI-ME signs and younger age had a higher degree of accuracy. This supports the claim that NBI-ME could be a reliable diagnostic modality for EoE/LyE predictors.

Similarity and difference in the characteristics of eosinophilic esophagitis between Western countries and Japan

“…Magnification endoscopy combined with narrow‐band imaging (NBIME) is a noninvasive optical technique that enables detailed visualization of capillary vessels in the esophageal mucosa and widely used for detection of esophageal neoplasm. Three signs identified by NBIME have been reported: (i) beige colored mucosa; (ii) increased and dot‐shaped congested intra‐epithelial papillary capillary loop; and (iii) invisibility of submucosal vessels, which have shown good inter‐ and intra‐observer agreement 75,76 . However, the usefulness of NBI or other image enhanced endoscopy (IEE) for diagnosis of EoE has yet to be studied.…”

“…Three signs identified by NBIME have been reported: (i) beige colored mucosa; (ii) increased and dot-shaped congested intra-epithelial papillary capillary loop; and (iii) invisibility of submucosal vessels, which have shown good inter-and intra-observer agreement. 75,76 However, the usefulness of NBI or other image enhanced endoscopy (IEE) for diagnosis of EoE has yet to be studied.…”

Magnifying Endoscopic Characteristics in Eosinophilic Esophagitis Patients

“…The microsurface pattern is a (8) granular surface without erosion. These ME-NBI features were selected from previous reports of EoE and other esophageal diseases like esophageal cancer (Figure 1a, c-g) [6,7]. We also scored the standard descriptors of EoE namely, (1) edema, (2) rings, (3) exudates, (4) furrows, and (5) stricture ( Fig.…”

Narrowed-spectrum Technologies in Endoscopic Imaging of The Upper Gastrointestinal Tract

“…A majority of patients with eosinophilic esophagitis (EoE) are likely to have observable features under NBI-ME, namely beige mucosa, dot-shaped IPCLs, and absence of submucosal (cyan-colored) vessels compared to those without this condition. 52,53 A combination of patient age, dot-shaped IPCLs, and absent cyan vessels were highly predictive of EoE (AUC 0.952). 52 NBI is also helpful in identifying endoscopic features associated with EoE 54 (rings, furrows, plaques), possibly increasing diagnostic sensitivity and allowing for targeted biopsies.…”

“…52,53 A combination of patient age, dot-shaped IPCLs, and absent cyan vessels were highly predictive of EoE (AUC 0.952). 52 NBI is also helpful in identifying endoscopic features associated with EoE 54 (rings, furrows, plaques), possibly increasing diagnostic sensitivity and allowing for targeted biopsies. 55 However, interobserver agreement regarding endoscopic features for EoE did not improve when NBI was added to WLE compared to WLE alone.…”