The Value Of High-definition Endoscopy With I-Scan In The Diagnosis Of GERD

Background:Gastroesophageal reflux disease (GERD) subsumes a wide variety of clinical manifestations, ranging from nonerosive reflux disease (NERD) that patients do not have visible morphologic changes at conventional endoscopy to reflux esophagitis and Barrett’s esophagus. GERD is one of the common GI diseases with a high occurrence rate and the disease is increasing in prevalence in China. The diagnosis and treatment of GERD are important because the disease, in addition to diminish health-related quality of life, has the risk of esophageal carcinoma in regard to Barrett’s esophagus. It is estimated that majority patients with GERD reveal no visible signs of endoscopic abnormality, but more and more research have confirmed that the minimal changes are found in the esophageal mucosa of patients with NERD, so the diagnosis of the NERD have important clinical significance.Objectives:To investigate the efficacy of high-definition endoscopy with i-scan to describe the characterisation of patients with NERD, and to compare the diagnostic value of three imaging modalities (HD+, HD+with i-Scan, and HD+with Lugol’s solution) for patients with possible erosive esophagitis.Methods:The distal esophagus of patients with heartburn and controls were inspected with three imaging modalities. First using HD+mode to observe; Then keep the scene fixed, switching to the i-scan combining with HD+mode, and was followed by20-mL Lugol’s solution. The presence or absence of erosive esophagitis was described by using the Los Angeles classification. Using high-definition endoscopy with i-scan minimal change lesions was described by punctate erythema proximal to the Z-line, triangular indentations into the squamous mucosa, and villous-like mucosa below the squamocolumnar junction. All the data were analyzed with SPSS13.0,variables were compared for significance with chi-squared test and Wilcoxon test. P-values <0.05were considered to be statistically significant.Results:From April to November2010, sixty consecutive patients with reflux symptoms or who were undergoing surveillance endoscopy (for known GERD) from outpatients at Qilu Hospital and41controls without reflux symptoms were informed about the purpose of this study.Forty-one were diagnosed with NERD by HD+endoscopy, thirty-one NERD were detected with HD+endoscopy with i-scan, whereas21NERD were diagnosed only by lugol chromoendoscopy.Using the high-definition endoscopy with i-scan, the small suspicious lesions were found in23(74%) of31NERD patients that show mucosal breaks consistent with the above mentioned subtle endoscopic features, and in9of41controls (22%) with mucosal breaks (P<0.01). Punctate erythema proximal to the Z-line was the only characterization found significantly more common in NERD patients (14/31versus7/41, P<0.01). The high-definition endoscopy with i-scan to predict NERD, a sensitivity of72%, a specificity of80%, a positive predictive value of74%and a negative predictive value of78%are found.The number of minimal change lesions could be increased from22(HD+) to61(HD+with i-Scan)(P<0.05).After detailed examination with HD+endoscopy alone,13patients were reflux esophagitis (Los Angeles A:n=8, B:n=4, C:n=1). Then the high-definition endoscopy with i-scan was used for further characterization, the reflux esophagitis were found in19patients (Los Angeles A:n=12; B:n=5; C:n=1; D:n=1). Eventually, more reflux esophagitis could be diagnosed using lugol chromoendoscopy (n=28vs. n=13; P<0.05). Conclusions:1. The high-definition endoscopy with i-scan can describe the characteristics of minimal change lesions, these endoscopic features of NERD patients for the endoscopic diagnosis are important.2. In discovering the number of minimal change lesions endoscopically, the high-definition endoscopy with i-scan is superior to HD+mode.3. Comparison of three models on the diagnosis rate of reflux esophagitis, we find that lugol’s solution in conjunction with HD+endoscopy significantly improves the identification of patients with reflux esophagitis.4. High-definition endoscopy with i-scan is a new product in endoscopic field, its clinical value need further research to clearify.