Clinical Application Of Blue Laser Magnification Endoscope In Non-erosive Reflux Disease

Objective: Non-erosive reflux disease(NERD)refers to the esophageal disease that has the clinical symptoms such as heartburn and acid reflux but did not show damage to the mucosa under ordinary endoscopic examination,which brings difficulties to the clinical diagnosis and treatment effect judgment of NERD.Intrapapillary capillary loop(IPCL)is a thinner vascular network rebranched from the dendritic vascular network of the esophageal mucosa,which morphological changes can be used to distinguish the nature of mucosal lesions such as inflammation,ulcer,or cancer.The morphology of IPCL in NERD patients is characterized by dilatation and/or lengthening,and microscopic findings of the above changes in this structure can help diagnose NERD.However,IPCL is difficult to be found under ordinary white light endoscopy,and it can only be observed after the mucosa is magnified.Blue laser magnification endoscope combines blue laser imaging technology with magnifying endoscope,so it can display IPCL clearly to observe its morphological changes.This study mainly discussed the morphological changes of IPCL in NERD patients under the blue laser magnification endoscope,so as to provide a basis for the endoscopic diagnosis and therapeutic effect evaluation of NERD.Methods: This research is divided into health group and NERD group.According to the inclusion criteria and exclusion criteria,non-erosive reflux patients admitted to Qingdao central hospital from January to October 2019 were selected as the NERD group.Health group contains healthy volunteers recruited at the same time.All the patients in the NERD group were given Gerd Q score and the score was recorded.All the research object receive blue laser magnifying endoscopy to observe IPCL type in BLI+ME mode and divided into IPCL ? group and IPCL ? group according to the shape of IPCL.IPCL ? type group form performance for regular arrangement curl and IPCL ? group form performance for expansion and/or lengthening,but still arrange regular.The IPCL ? group take two or three pieces of tissue to do the histopathological examination.All the patients were treated with pantoprazole sodium enteric capsule combined with itopril hydrochloride dispersible tablets for eight weeks and receive Gerd questionnaire after treatment.Type of IPCL ? group review blue laser magnifying endoscopy,observing IPCL form changes before and after treatment.Result: A total of 20 healthy volunteers were recruited for this study,including 12 males and 8 females.There were 53 cases of non-erosive reflux disease which came to Qingdao central hospital for medical treatment,and the number of males and females was 26 and 27.There was no significant difference in age and BMI between the two groups(P > 0.05).After blue laser magnification endoscopy,it was found that 90%(18/20)of the healthy group had normal IPCL morphology,and only two cases had IPCL morphology changing.NERD group found that IPCL ? type group was 15.1%(8/53),IPCL morphology change group was 84.9%(45/53).The IPCL ? and ? groups did the Gerd Q score again after treatment of eight weeks.Gerd Q scores in the two groups were 10.88±1.36 and 11.62±1.71 before treatment.After treatment,the scores were 7.00±0.53 and 6.84±0.79 respectively.There was no statistically significant difference between the two groups,but there was significant difference no matter in IPCL ? group or IPCL ? group before and after treatment(P<0.05).Group after treatment of the IPCL ? group review blue laser magnification endoscopy examination.Results prove that IPCL form back to normal in 77.8%(35/45)of patients,22.2% is still characterized by morphological changes.Conclusion: Changes in IPCL morphology can help distinguish normal mucosa from diseased mucosa,and this structure can be clearly observed by blue laser magnification endoscope.Healthy people's IPCL is normal ? type performance.Although no mucosal damage can be observed in non-erosive reflux disease under white light endoscopy,IPCL form changing can be observed under blue laser magnifying endoscopy.Pathology helps identify inflammatory infiltrations.Most of the IPCL morphology can return to normal after regular treatment.