Role of I-scan in Diagnosis of Duodenal Mucosal Lesions during Gastroduodenoscopy

Abstract

Background and study aim: Duodenal mucosal lesions are usually difficult to diagnose. White light endoscopy(WLE) generally does not visualize the duodenal villous patterns properly and miss small elevated lesions, which result in an inaccurate diagnosis. We aimed to assess the diagnostic accuracy of I-scan technology for evaluation and histological confirmation of mucosal lesions in the duodenum and its role in biopsy targeting. Patients and Method:This was a single center, cross-sectional study. Patients with any indication for duodenal mucosa histological examination on conventional white light endoscopy WLE and I Scan imaging were included. A definitive diagnosis was determined by histopathology examination of the biopsied specimen.Results: In our study 41 patients were included (25 males, 16 females, mean age 39.9 years). The criterion-related validity of I-scan as a diagnostic test was 91.9% sensitivity, 75% specificity, 97.1% PPV and 50% NPV compared to white light endoscopy , which achieved 67.6% sensitivity, 75% specificity, 96% PPV and 20% NPV. I-scan achieved 95.1% accuracy, 97% specificity, 75% sensitivity in the diagnosis of celiac disease and detection of duodenal villous atrophy compared to WLE, which achieved 92.7% accuracy, 100% specificity, 25% sensitivity. There was a significant association between disease diagnosis by I-scan and presenting by abdominal pain (p<0.026). Conclusion: I-scan represents a simpletechnique that helps in the diagnosis of duodenal mucosal lesions with high sensitivity, specificity and reduces false negative diagnosis; especially in patients who had abdominal pain.