i-Scan detection of minimal change esophagitis in dyspeptic patients with or without Gastroesophageal Reflux disease

Abstract

BackgroundThe association of minimal change esophagitis (MCE) with GERD is controversial. i-Scan endoscopy (SE) provides high resolution and modulation of images that may improve minimal change lesion (MCL) detection. We aimed to assess the efficacy of SE in detecting MCL in dyspeptic patients with GERD compared with patients without GERD by GerdQ or by endoscopy with 24-h pH monitoring (PHM) and in normal volunteers.MethodsThis is a cohort study conducted at a tertiary center. All dyspeptic patients were prospectively recruited. All patients completed a validated Thai version of GerdQ and then underwent endoscopy. Forty normal volunteers as a control group were recruited for endoscopy. The distal esophagus was examined by high definition endoscopy and SE sequentially. All had PHM done. GERD was diagnosed by Los Angeles classification A-D and/or by a positive PHM. MCE was diagnosed when MCL or combination of MCL was present.ResultsOf 174 patients, 144 completed the study protocol. After the exclusion of 6 patients, 138 remained for analysis. Overlapping GERD symptoms were found in 44.2 % and 26.8 % had confirmed GERD. Group A was comprised of 61 patients with a positive GerdQ and 77 patients in group B had a negative GerdQ. Twenty-four in group A, 28 in group B and 7 in the control group had MCE that was not significantly different. MCE in GERD was significantly higher (51.45 %) than in non-GERD (32.7 %) (p = 0.047) and in the control group (20.58 %) (p = 0.007). The sensitivity, specificity, positive predictive value, and negative predictive value of SE were 51.35 %, 67.33 %, 36.54 % and 79.06 %, respectively.ConclusionIn dyspeptic patients, SE detected more MCE in GERD than in non-GERD patients and in the control group.Trial registrationClinicalTrials.gov number NCT01742377

Ambulatory 24-hour multichannel intraluminal impedance-pH monitoring and high resolution endoscopy distinguish patients with non-erosive reflux disease from those with functional heartburn

“…When minimal changes were analyzed by using more than one endoscopic finding, same results were found between the two groups with sensitivity of 87.5% and positive predictive value of 85.7%. This was consistent with Rey JW et al’s result [18] but not that of Netinatsunton et al’s study [20]. Rey and his colleges performed high definition endoscopy with i-scan imaging and Lugol’s solution for the detection of inflammation in NERD patients.…”

“…They showed 82.5%sensitivity and 100% positive predictive values for i-scan endoscopy in detecting minimal erosive reflux disease. The difference may be due to lack of standardized definition for minimal changes, lack of definitive gold standard test for minimal changes, and different study populations, endoscopic instruments and imaging technologies [10, 20, 36]. Therefore, multi-center prospective studies need to be conducted with standard definitions and more accurate diagnostic tools in the future.…”

“…Kim et al [19] showed that i-scan endoscopy identified more minimal changes than conventional endoscopy and therefore increased the efficiency of GERD diagnosis. More recently, a cohort study was conducted to assess the efficacy of i-scan endoscopy in detecting minimal change lesions in dyspeptic patients with or without GERD [20]. They showed that i-scan endoscopy detected more minimal change esophagitis in GERD patients than non-GERD patients, albeit with a low sensitivity and specificity.…”

Linked color imaging improves detection of minimal change esophagitis in non-erosive reflux esophagitis patients

“…Improvement in the detection rates resulted from use of the LCI technology, which often generates a bright field of view and can produce differences in color contrast in surrounding vessels, enabling easier detection of minimal changes in evaluation of the distal esophagus area. Previous studies also showed that IEE technologies, such as NBI, FICE and i-Scan, improved detection rates for esophageal injury 4 18 19 20 . However, those technologies also have some limitations.…”

Image-enhanced endoscopy is specific for the diagnosis of non-erosive gastroesophageal reflux disease

“…A more recent study included patients with dyspepsia who were stratified into those with and without GERD symptoms based on a GerdQ score 18 ; many patients also underwent 24-hr pH monitoring. GERD diagnosis was based on intra-esophageal acid exposure, positive symptom index or symptom association probability, or erosive esophagitis, unrelated to presence of absence of GERD symptoms.…”