Division of Surgery and Interventional Science, University College London, United Kingdom.
Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, United Kingdom.
Endoscopy. 2017 Dec;49(12):1219-1228. doi: 10.1055/s-0043-113441. Epub 2017 Jul 21.
Enhanced endoscopic imaging with chromoendoscopy may improve dysplasia recognition in patients undergoing assessment of Barrett's esophagus (BE). This may reduce the need for random biopsies to detect more dysplasia. The aim of this study was to assess the effect of magnification endoscopy with I-SCAN (Pentax, Tokyo, Japan) and acetic acid (ACA) on dysplasia detection in BE using a novel mucosal and vascular classification system. BE segments and suspicious lesions were recorded with high definition white-light and magnification endoscopy enhanced using all I-SCAN modes in combination. We created a novel mucosal and vascular classification system based on similar previously validated classifications for narrow-band imaging (NBI). A total of 27 videos were rated before and after ACA application. Following validation, a further 20 patients had their full endoscopies recorded and analyzed to model use of the system to detect dysplasia in a routine clinical scenario. The accuracy of the I-SCAN classification system for BE dysplasia improved with I-SCAN magnification from 69 % to 79 % post-ACA ( = 0.01). In the routine clinical scenario model in 20 new patients, accuracy of dysplasia detection increased from 76 % using a "pull-through" alone to 83 % when ACA and magnification endoscopy were combined ( = 0.047). Overall interobserver agreement between experts for dysplasia detection was substantial (0.69). A new I-SCAN classification system for BE was validated against similar systems for NBI with similar outcomes. When used in combination with magnification and ACA, the classification detected BE dysplasia in clinical practice with good accuracy.Trials registered at ISRCTN (58235785).
放大内镜联合染色内镜可提高 Barrett 食管（BE）患者异型增生的识别率，从而减少随机活检以发现更多异型增生的需求。本研究旨在评估放大内镜联合 I-SCAN（Pentax，日本东京）和醋酸（ACA）对 BE 异型增生的检测效果，采用新型的黏膜和血管分类系统。
高清白光内镜下记录 BE 段和可疑病变，结合所有 I-SCAN 模式增强放大内镜记录。我们根据窄带成像（NBI）的类似验证分类方法，建立了一种新的黏膜和血管分类系统。共对 27 个视频进行了 ACA 应用前后的评分。验证后，对另外 20 例患者进行了全内镜记录和分析，以建立该系统在常规临床情况下检测异型增生的模型。
I-SCAN 分类系统对 BE 异型增生的准确性随着 I-SCAN 放大倍数的增加而提高，从 ACA 前的 69%提高到 79%（ = 0.01）。在 20 例新患者的常规临床情景模型中，单独使用“拉过式”检查时，异型增生检测的准确性为 76%，而联合使用 ACA 和放大内镜时，准确性提高到 83%（ = 0.047）。专家对异型增生检测的总体观察者间一致性为中等（0.69）。
一种新的 I-SCAN 分类系统用于评估 BE，其与 NBI 的类似系统具有相似的结果。当与放大和 ACA 联合使用时，该分类系统以良好的准确性检测出 BE 异型增生。试验在 ISRCTN（58235785）注册。
