The added value of magnifying endoscopy in diagnosing patients with certain gastroesophageal reflux disease

Wasielica-Berger, Justyna; Kemonä, A; Kiśluk, Joanna; Świdnicka-Siergiejko, Agnieszka Katarzyna; Rogalski, Paweł; Chwiesko, Adam; Kostrzewska, Maja; Dâbrowski, A

doi:10.1016/j.advms.2018.04.006

Cited by 7 publications

(11 citation statements)

References 28 publications

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“…Abnormal findings include micro-erosions, abnormal intrapapillary capillary loops and obscured palisade vessels which can be seen in NERD and ERD. 31,32 Studies have shown that, in experienced hands, magnifying endoscopy can approach a sensitivity of >90% for NERD, with strong negative predictive values. 33 However, many of these techniques are not used in a widespread manner in North America, and differences in operator experience may contribute to significant interobserver differences.…”

Section: Number Of Studies Included Resultsmentioning

confidence: 99%

“…In particular, magnifying endoscopy and narrow band imaging have been studied to diagnose NERD. Abnormal findings include micro‐erosions, abnormal intrapapillary capillary loops and obscured palisade vessels which can be seen in NERD and ERD 31,32 . Studies have shown that, in experienced hands, magnifying endoscopy can approach a sensitivity of >90% for NERD, with strong negative predictive values 33 .…”

Section: Discussionmentioning

confidence: 99%

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The role of histology in the diagnosis of non‐erosive reflux disease: A systematic review and meta‐analysis

Kataria

Rivera

Grin

et al. 2023

Neurogastroenterology Motil

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Background and PurposeNon‐erosive reflux disease (NERD) accounts for over half of all gastroesophageal reflux cases and is characterized by reflux symptoms with pathologic acid exposure on pH monitoring but no evidence of erosions on upper endoscopy. Ambulatory pH monitoring is limited by availability and patient tolerance. The utility of performing esophageal mucosal biopsies in diagnosing NERD is unclear. We conducted a systematic review and meta‐analysis to determine the sensitivity of esophageal mucosal biopsies in diagnosing NERD.MethodsData were obtained from Embase and Ovid MEDLINE from inception to April 2021. Studies were included if esophageal mucosal biopsies were taken and analyzed using conventional histopathologic analysis in symptomatic NERD patients. Relevant data was including histologic abnormalities and location of the biopsy. Sensitivity and specificity were calculated against healthy controls or those with functional heartburn.ResultsThe search yielded 2871 studies, of which 10 studies met our inclusion criteria and contained raw data. Histological abnormalities included histologic sum scores, papillary elongation, basal cell hyperplasia, and dilated intraepithelial spaces. When assessing for the presence of any abnormality, biopsies taken <3 cm from the lower esophageal sphincter (LES) had a pooled sensitivity of 0.71 (95% CI 0.64–0.77) and specificity of 0.64 (95% 0.54–0.73); however, analysis of individual histologic features such as the presence of eosinophils improved the sensitivity.ConclusionsAlthough esophageal mucosal biopsies had poor sensitivity at diagnosing NERD, biopsies taken within 3 cm of the LES had higher sensitivity when pathologists reported upon eosinophils and dilated intraepithelial spaces.

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Section: Number Of Studies Included Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The role of histology in the diagnosis of non‐erosive reflux disease: A systematic review and meta‐analysis

Kataria

Rivera

Grin

et al. 2023

Neurogastroenterology Motil

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“…Finally, the additional use of magnifying endoscopy might have changed the results. Previous studies on magnification endoscopy and esophagitis with minimal change in NERD patients showed substantial inter‐observer agreement 24‐26 . However, although magnification endoscopy might increase the diagnostic accuracy of esophagitis LA‐M, the test is not feasible in every endoscopy units.…”

Section: Discussionmentioning

confidence: 98%

Inter‐observer variability of experts and trainees for the diagnosis of reflux esophagitis: Comparison of linked color imaging, blue laser imaging, and white light imaging

Lee

Kae

Jang

et al. 2021

J of Digest Diseases

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Objectives Diagnosis of reflux esophagitis according to the Los Angeles classification minimal change (LA‐M) has a low inter‐observer agreement. We aimed to investigate whether the inter‐observer agreement of reflux esophagitis was better when expert endoscopists read the endoscopic images, or when the linked color imaging (LCI) or blue laser imaging (BLI)‐bright mode was used. In addition, whether the inclusion of LA‐M in the definition of reflux esophagitis affected the consistency of the diagnosis was investigated. Methods During upper endoscopy, endoscopic images of the gastroesophageal junction were taken using white light imaging (WLI), BLI‐bright, and LCI modes. Four expert endoscopists and four trainees reviewed the images to diagnose reflux esophagitis according to the modified LA classification. Results The kappa values for the inter‐observer variability for the diagnosis of reflux esophagitis were poor to fair among the experts (κ = 0.22, 0.17, and 0.27 for WLI, BLI‐bright, and LCI, respectively) and poor among the trainees (κ = 0.18, 0.08, and 0.14 for WLI, BLI‐bright, and LCI). The inter‐observer variabilities for the diagnosis of reflux esophagitis excluding LA‐M were fair to moderate (κ = 0.42, 0.35, and 0.42 for WLI, BLI‐bright, and LCI) among the expert endoscopists and moderate among the trainees (κ = 0.48, 0.43, and 0.51 for WLI, BLI‐bright, and LCI). Conclusions The inter‐observer agreement for the diagnosis of reflux esophagitis was very low for both the expert endoscopists and the trainees, even using BLI‐bright or LCI mode. However, when reflux esophagitis LA‐M was excluded from the diagnosis of esophagitis, the degree of inter‐observer agreement increased.

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“…The strength of agreement was calculated as κ values. Values ranging from 0.01 to 0.20 were interpreted as slight agreement, 0.21 to 0.40 as fair agreement, 0.41 to 0.60 as moderate agreement, 0.61 to 0.80 as substantial agreement, and 0.81 to 0.99 as almost perfect agreement 18…”

Section: Methodsmentioning

confidence: 99%

Evaluation of Minimal Change Lesions Using Linked Color Imaging in Patients With Nonerosive Reflux Esophagitis

Zhang

Sun

Shi

et al. 2021

Journal of Clinical Gastroenterology

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Background and Aims: High prevalence of minimal change lesion (MCL) in nonerosive reflux esophagitis (NERD) patients is commonly recognized by many endoscopists. However, it is difficult to detect MCL with conventional white-light imaging (WLI) endoscopy. Linked color imaging (LCI), a novel image-enhanced endoscopy technology with strong, unique color enhancement, is used for easy recognition of early gastric cancer and detection of Helicobacter pylori infection. The aim of the study was to compare the efficacy of LCI and WLI endoscopy in evaluating MCL in patients with NER. Materials and Methods: Forty-one patients with NERD and 38 subjects with nongastroesophageal reflux disease (non-GERD) were recruited in this study between August 2017 and July 2018. During upper gastrointestinal endoscopy, the distal 5 cm of the esophageal mucosal morphology at the squamocolumnar junction was visualized using WLI followed by LCI. MCL was defined as areas of erythema, blurring of the Z-line, friability, decreased vascularity, white turbid discoloration, and edema or accentuation of the mucosal folds. Three experienced endoscopists evaluated the color patterns for MCL on WLI images and on WLI combined with LCI images in both groups. A biopsy was taken 2 cm above the esophagogastric junction. Histologic slides were scored by a pathologist in a blinded manner. Results: The proportion of MCL was higher in the patients with NERD (70.7%, 29/41) than in patients with non-GERD (39.5%, 15/38) using WLI combined with LCI. In 12 patients with NERD, both WLI and LCI showed normal mucosa. The MCL detection rate was significantly higher when using WLI combined with LCI than when using WLI (70.7% vs. 51.2%, P=0.039) in patients with NERD. The histopathologic score of MCL (+) was significantly higher than that of MCL (−) patients in both the NERD group (4.59±0.32 vs. 2.36±0.34, P<0.01) and the non-GERD group (3.47±0.50 vs. 2.00±0.28, P<0.01). The intraobserver reproducibility levels and interobserver agreement were better with LCI than with WLI alone. Conclusions: Frequency of MCL was higher in patients with NERD than in those with non-GERD. MCL can be identified by using WLI combined with LCI in patients with NERD. By enhancing endoscopic images, LCI is more sensitive in detecting MCL compared with WLI.

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The added value of magnifying endoscopy in diagnosing patients with certain gastroesophageal reflux disease

Cited by 7 publications

References 28 publications

The role of histology in the diagnosis of non‐erosive reflux disease: A systematic review and meta‐analysis

The role of histology in the diagnosis of non‐erosive reflux disease: A systematic review and meta‐analysis

Inter‐observer variability of experts and trainees for the diagnosis of reflux esophagitis: Comparison of linked color imaging, blue laser imaging, and white light imaging

Evaluation of Minimal Change Lesions Using Linked Color Imaging in Patients With Nonerosive Reflux Esophagitis

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