Minimal Esophageal Lesions Detected by Digital Chromoendoscopy Using Optical Enhancement SystemTM Associated to High Definition Plus Optical Magnification in Non-Erosive Reflux Disease (NERD)

Abstract

Introduction: Patients with GERD have an increased number, dilation and tortuosity of microscopic intra-papillary capillary loops (IPCLs). Recently, an image-enhanced technology called Optical Enhancement system (OE systemTM) is equipped in Pentax video processor EPK-i7010. It improves visualization of microvessels. Also new high definition scopes with optical magnification (MagniviewTM) were developed (increase image >136 times). AIM: To evaluate diagnosis ability of OE systemTM +MagniviewTM scopes detecting minimal esophageal lesions IPCLs and predicting reflux in non-erosive reflux disease (NERD).Figure: Red ROC curve: pH-Impedanciometry. Blue ROC curve: Biopsy. UELS: Upper endoscopy low segment. UEMS: Upper endoscopy middle segment. UEUP: Upper endoscopy upper segment. UEG: Upper endoscopy in general.Table: Table. Contingency Table comparing Upper Endoscopy with Ph-Impedanciometry and histopathological BiopsyMethods: Prospective, non-randomized study. Patients enrolled had GERD symptoms. If esophagus was normal at endoscopy, pH-impedanciometry was performed to discriminate NERD patients (NG) from non reflux disease (Control group, CG). OE systemTM+MagniviewTM endoscopy was performed. Images were recorded and examined blindly by 3 endoscopists. Biopsies from each esophagus level were done. Images were compared to histology to predict inflammation. Inclusion Criteria: >18 years-old, >8 points at GERD questionnaire), abcense of Barrett's esophagus or erosive sign (Los Angeles classification grade A-D) by endoscopy (by neither white light nor I-ScanTM). Exclusion Criteria: History of esophagitis, achalasia, esophageal varices, esophageal cancer, PPI or NSAIDs consumption, coagulopathy, gastric lesions, gastroparesis, esophageal/gastric surgery, pregnancy. Results: 57 patients were analyzed [36 (63.2%) NG, 21 (36.9%) CG] [mean age 48 yo, 46 women (81%)]. Main symptom was regurgitation in 27 cases (47.3%). IPCLs was observed in 94.4% of NG, being lower third the most affected (P<0.05). In CG 8 patients (38%) had IPCLs (P<0.05 for NG). IPCLs dilatation was most common find (91.6%). Unlike IPCLs tortuosity, both dilatation and increased number of IPCLs showed a significant difference between groups. Also both lesions were more common (P<0.05) between patients with inflammation at histology. OE systemTM+Magniview scopes ability predicting GERD (gold standard: pH-Impedanciometry) reached sensitivity, specificity, PPV, NPV and accuracy of 94.4, 61.9, 91.4, 81.8 and 86.67% respectively. Lower third of esophagus had higher sensibility and accuracy (88.9 and 87.7%). Kappa inter and intra-observer value was 0.85 and 0.90 respectively. Conclusion: OE systemTM+MagniviewTM scopes can detect IPCLs and predict NERD with high sensitivity and accuracy.