Is Conventional Endoscopic Identification of Non-Erosive Reflux Disease Adequate?

Falk, Gary W.

doi:10.1159/000151251

Cited by 10 publications

(9 citation statements)

References 34 publications

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“…Several other studies confirm this thesis. As Falk showed in their overview, it is difficult to grade NERD patients even with the use of most recent endoscopic techniques . Studies performed in Japan using high‐resolution endoscopy revealed several inflammatory lesions in NERD patients, but similar lesions were found in the control population as well …”

Section: Discussionmentioning

confidence: 99%

High-definition endoscopy withiScan and Lugol's solution for the detection of inflammation in patients with nonerosive reflux disease: histologic evaluation in comparison with a control group

Deris

Marquardt

Thomaidis

et al. 2016

Diseases of the Esophagus

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Nonerosive reflux disease (NERD) is commonly diagnosed in patients with symptoms of reflux. The aim of the present study was to determine whether high-definition endoscopy (HD) plus equipped with the iScan function or chromoendoscopy with Lugol's solution might permit the differentiation of NERD patients from those without reflux symptoms, proven by targeted biopsies of endoscopic lesions. A total of 100 patients without regular intake of proton pump inhibitors and with a normal conventional upper endoscopy were prospectively divided into NERD patients and controls. A second upper endoscopy was performed using HD+ with additional iScan function and then Lugol's solution was applied. Biopsy specimens were taken from the gastroesophageal junction in all patients. A total of 65 patients with reflux symptoms and 27 controls were included. HD(+) endoscopy with iScan revealed subtle mucosal breaks in 52 patients; the subsequent biopsies confirmed esophagitis in all cases. After Lugol's solution, 58 patients showed mucosal breaks. Sensitivity for the iScan procedure was 82.5%, whereas that for Lugol's solution was 92.06%. Excellent positive predictive values of 100% and 98.3%, respectively, were noted. The present study suggests that the majority of patients with NERD and typical symptoms of reflux disease can be identified by iScan or Lugol's chromoendoscopy as minimal erosive reﬂux disease (ERD) patients.

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Section: Discussionmentioning

confidence: 99%

High-definition endoscopy withiScan and Lugol's solution for the detection of inflammation in patients with nonerosive reflux disease: histologic evaluation in comparison with a control group

Deris

Marquardt

Thomaidis

et al. 2016

Diseases of the Esophagus

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“…Furthermore, current magnification endoscopy requires substantial expertise to obtain and interpret endoscopic images, which has limited its widespread acceptance. Therefore, the usefulness of magnification endoscopy and NBI in diagnosing GERD, so far, remains unclear . The unique advantage of AFI over magnifying NBI is the simple criterion of one or more longitudinal purple lines > 1 cm.…”

Section: Discussionmentioning

confidence: 99%

“…These GERD‐related cellular changes have prompted attempts to utilize techniques such as magnification endoscopy and narrow band imaging (NBI) to diagnose GERD. However, they are not widely utilized due to the limitations of lack of clearly defined diagnostic criteria, problematic inter‐observer agreements, or being time consuming …”

Section: Introductionmentioning

confidence: 99%

“…However, they are not widely utilized due to the limitations of lack of clearly defined diagnostic criteria, problematic inter-observer agreements, or being time consuming. 12,13 Autofluorescence imaging (AFI) is an optical digital imaging technology that detects autofluorescence emitted in response to light by endogenous fluorophores in the gastrointestinal (GI) tract. Its ability to identify indistinct mucosal lesions based on differences in tissue fluorescence not visible on standard white light imaging (WLI) has made AFI endoscopy useful in the diagnosis of precancerous lesions and early stage cancer in Barrett's esophagus when combined with WLI.…”

Section: Introductionmentioning

confidence: 99%

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Autofluorescence imaging endoscopy for predicting acid reflux in patients with gastroesophageal reflux disease

Wang

Uedo

Yang

et al. 2014

J of Gastro and Hepatol

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Background and Aim Endoscopic diagnosis of gastroesophageal reflux disease (GERD) remains challenging. Autofluorescence imaging (AFI) can identify indistinct mucosal lesions; however, its ability to diagnose GERD has not been determined. This study aimed to compare the diagnostic capabilities of standard white light imaging (WLI) and AFI using pH/impedance testing as gold standard. Methods In this prospective observational trial, 95 consecutive patients with classic reflux symptoms were screened in two tertiary care referral hospitals and 82 were included. GerdQ questionnaire was administered to each patient. Endoscopy with WLI and AFI, and ambulatory 24‐h pH/impedance monitoring were performed. Erosive esophagitis on WLI was defined as positive for GERD, whereas on AFI endoscopy, the appearance of one or more longitudinal purple lines > 1 cm was defined as indicative of GERD. We assessed the diagnostic capacities of each method, as well as inter‐observer agreement on AFI findings. We also looked at factors associated with having a positive AFI finding. Results The sensitivity and accuracy of AFI (77% and 67%, respectively) in detecting GERD were higher than those of WLI (21% and 52%, respectively), although the specificity of AFI (53%) was lower than that of WLI (97%); McNemar test showed a significant difference (P = 0.000). Inter‐observer reliability analysis of AFI findings indicated substantial agreement (Kappa = 0.630, P = 0.000). Multivariate analysis showed that abnormal AFI findings significantly correlated with positive pH/impedance result (odds ratio = 0.242, 95% confidence interval = 0.087–0.673, P = 0.007). Conclusions AFI can reveal GERD‐related mucosal changes, invisible on conventional WLI, thus improve the endoscopic diagnosis of GERD.

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“…Techniques that are currently under investigation include high-resolution endoscopy, magnifying endoscopy, chromoendoscopy, narrowband imaging, and confocal endomicroscopy. All of these new techniques can identify minimal abnormalities and differentiate them from SS-CLE in a superior manner to standard white light endoscopy [31], so those methods may solve this problem in the future.…”

Section: Discussionmentioning

confidence: 99%

Interobserver agreement on endoscopic diagnosis of low-grade reflux esophagitis, including minimal changes

et al. 2012

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Background In Japan, the majority of patients with gastroesophageal reflux disease have low-grade reflux esophagitis (RE), including minimal changes, and the modified Los Angeles (LA) classification is widely used. However, there have been few evaluations of interobserver agreement with this classification. This study was performed to elucidate the level of interobserver agreement for diagnosis low-grade RE, including minimal changes, and to identify any clinical factors that influenced the results. Methods A total of 114 endoscopists from university hospitals, community hospitals, and private practice participated. They assessed the grade of esophagitis in 8 patients by viewing endoscopic images. The images were projected onto a screen, and all of the endoscopists reviewed images together. The diagnosis was selected from the following five categories: grade M, grade A, shortsegment columnar-lined esophagus, diagnosis difficult due to poor image quality, and others. After discussiing the endoscopic diagnosis, the images were projected in a random order and the endoscopists viewed them again. Kappa coefficients of reliability were calculated before and after the discussion, and we also evaluated factors influencing the results. ResultsThe kappa values obtained before and after discussion were 0.41 and 0.70, respectively. We found three factors that influenced interobserver agreement: specialty, years of experience with endoscopic examination, and mean esophageal observation time per endoscopic examination. Conclusions The modified LA classification is reliable for diagnosing low-grade RE (including minimal changes) in Japan, although several factors can influence interobserver agreement.

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Is Conventional Endoscopic Identification of Non-Erosive Reflux Disease Adequate?

Cited by 10 publications

References 34 publications

High-definition endoscopy withiScan and Lugol's solution for the detection of inflammation in patients with nonerosive reflux disease: histologic evaluation in comparison with a control group

High-definition endoscopy withiScan and Lugol's solution for the detection of inflammation in patients with nonerosive reflux disease: histologic evaluation in comparison with a control group

Autofluorescence imaging endoscopy for predicting acid reflux in patients with gastroesophageal reflux disease

Interobserver agreement on endoscopic diagnosis of low-grade reflux esophagitis, including minimal changes

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