High-resolution chromoendoscopy in the esophagus

Sidorenko, Elena

doi:10.1016/j.giec.2004.03.003

Cited by 11 publications

(5 citation statements)

References 44 publications

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“…41 It has been our practice, and that of others, to combine the use of EMR with subsequent porfimer sodium PDT to eliminate all glandular epithelium to prevent the subsequent development of recurrent or metachronous carcinomas. 46 Chromendoscopy of the esophagus predominantly consists of methylene blue staining for the assessment of BE. While balloon cytology for esophageal cancer screening has mostly been used in Asia, similar devices are under development in the United States.…”

Section: Detection Of Barrett's Dysplasiamentioning

confidence: 99%

Present Status of Photodynamic Therapy for High-Grade Dysplasia in Barrett??s Esophagus

Wolfsen

2005

Journal of Clinical Gastroenterology

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Previously, Barrett's high-grade dysplasia patients were routinely referred for esophageal resection surgery based upon the assumption of inevitable progression to cancer, the high rate of undiagnosed synchronous cancers, and few treatment alternatives. Important developments in Barrett's high-grade dysplasia include recent publications regarding the natural history of Barrett's high-grade dysplasia and the regulatory approval for endoscopic ablation therapy using porfimer sodium photodynamic therapy (Photofrin PDT).

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Section: Detection Of Barrett's Dysplasiamentioning

confidence: 99%

Present Status of Photodynamic Therapy for High-Grade Dysplasia in Barrett??s Esophagus

Wolfsen

2005

Journal of Clinical Gastroenterology

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“…Magnification enlarges the images, and high resolution improves the ability to detect minute details. Advances in optical engineering have made it possible to have a movable zoom lens in the tip of the magnification endoscopes that can provide up to 150-fold magnification and high-resolution endoscopes that use 850,000 pixels to provide high-resolution images ( 21 ). In a comparative study, consecutive patients who presented for EGD were divided into those with reflux symptoms (NERD group, N = 39) and non-reflux patients (control group, N = 39) with the help of a questionnaire; the endoscopists were blinded to the presence of reflux symptoms.…”

Section: Advances In Endoscopic Imaging For Gerdmentioning

confidence: 99%

“…These dyes are not absorbed into cells but highlight the mucosal patterns in different structures by filling mucosal pits and folds. Chromoendoscopy is often used along with high-resolution and high-magnification endoscopy ( 21 , 25 , 26 ). Yoshikawa et al conducted a study to determine the usefulness of Lugol chromoendoscopy for the diagnosis of NERD.…”

Section: Advances In Endoscopic Imaging For Gerdmentioning

confidence: 99%

Advanced Endoscopic Imaging and Interventions in GERD: An Update and Future Directions

et al. 2021

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Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases encountered in primary care and gastroenterology clinics. Most cases of GERD can be diagnosed based on clinical presentation and risk factors; however, some patients present with atypical symptoms, which can make diagnosis difficult. An esophagogastroduodenoscopy can be used to assist in diagnosis of GERD, though only half of these patients have visible endoscopic findings on standard white light endoscopy. This led to the development of new advanced endoscopic techniques that enhanced the diagnosis of GERD and related complications like squamous cell dysplasia, Barrett's esophagus, and early esophageal adenocarcinoma. This is conducted by improved detection of subtle irregularities in the mucosa and vascular structures through optical biopsies in real-time. Management of GERD includes lifestyle modifications, pharmacological therapy, endoscopic and surgical intervention. Minimally invasive endoscopic intervention can be an option in selected patients with small hiatal hernia and without complications of GERD. These endoscopic interventions include endoscopic fundoplication, endoscopic mucosal resection techniques, ablative techniques, creating mechanical barriers, and suturing and stapling devices. As these new advanced endoscopic techniques are emerging, data surrounding the indications, advantages and disadvantages of these techniques need a thorough understanding.

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“…7,8,9,10 Unfortunately, intramucosal neoplasia can appear as small erosions, flat mucosal lesions, or normal mucosa making it difficult to visualize on routine high-definition white light endoscopy (HD-WLE) even for advanced endoscopists. 11 Currently, endoscopic screening and surveillance is performed in high-risk patients using Lugol's chromoendoscopy (LCE). 12,13,14 Although LCE increases the sensitivity of HD-WLE to > 95%, specificity remains poor (< 65%) as inflammation and benign mucosal changes mimic neoplasia, resulting in unnecessary biopsies (LCE positive, pathology negative) and increased cost.…”

Section: Introductionmentioning

confidence: 99%

Low-Cost High-Resolution Microendoscopy for the Detection of Esophageal Squamous Cell Neoplasia: An International Trial

Protano

Wang

et al. 2015

Gastroenterology

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Background and Aims Esophageal squamous cell neoplasia (ESCN) has high mortality due to late detection. In high risk regions such as China, screening is performed by Lugol's chromoendoscopy (LCE). LCE has low specificity resulting in unnecessary tissue biopsy with subsequent increase in procedure cost and risk. The purpose of this study is to evaluate the accuracy of a novel, low-cost high resolution microendoscope (HRME) as an adjunct to LCE. Methods In this prospective trial, 147 consecutive high-risk patients were enrolled from two US and two Chinese tertiary centers. Three expert and four novice endoscopists performed white light endoscopy followed by LCE and HRME. All optical images were compared to gold standard of histopathology. Results Using a per biopsy analysis, sensitivity of LCE vs. LCE + HRME was 96% vs. 91% (p=0.0832), specificity 48% vs. 88% (p<0.001), PPV 22% vs 45% (p<0.0001), NPV 98% vs. 98% (p=0.3551), and overall accuracy 57% vs. 90% (p<0.001). Using a per patient analysis, sensitivity of LCE vs. LCE + HRME was 100% vs. 95% (p=0.16), specificity 29% vs. 79% (p<0.001), PPV 32% vs. 60%, 100% vs. 98%, and accuracy 47% vs. 83% (p<0.001). With use of HRME, 136 biopsies (60%; 95% CI: 53-66%) could have been spared, and 55 patients (48%; 95% CI: 38-57%) spared any biopsy. Conclusion In this trial, HRME improved the accuracy of LCE for ESCN screening and surveillance. HRME may be a cost-effective “optical” biopsy adjunct to LCE, potentially reducing unnecessary biopsy and facilitating real-time decision-making in globally underserved regions; ClinicalTrials.gov, NCT 01384708.

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High-resolution chromoendoscopy in the esophagus

Cited by 11 publications

References 44 publications

Present Status of Photodynamic Therapy for High-Grade Dysplasia in Barrett??s Esophagus

Present Status of Photodynamic Therapy for High-Grade Dysplasia in Barrett??s Esophagus

Advanced Endoscopic Imaging and Interventions in GERD: An Update and Future Directions

Low-Cost High-Resolution Microendoscopy for the Detection of Esophageal Squamous Cell Neoplasia: An International Trial

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