Robles-Medranda Carlos, Valero Manuel, Soria-Alcívar Miguel, Puga-Tejada Miguel, Oleas Roberto, Ospina Jesenia, Alvarado-Escobar Haydee, Baquerizo-Burgos Jorge, Pitanga-Lukashok Hannah
Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador.
Endosc Int Open. 2019 Aug;7(8):E979-E986. doi: 10.1055/a-0953-1844. Epub 2019 Jul 24.
The aim of this study was to evaluate the diagnostic yield of endoscopy using optical enhancement (OE system) with optical magnification to predict reflux in non-erosive reflux disease (NERD) patients. A prospective, non-randomized, single-blind study was performed from September 2015 to January 2016. Participants suffered from gastroesophageal reflux disease (GERD) symptoms and were assigned to the NERD group or the non-reflux disease control group based on endoscopic findings and a 24-hour pH-impedance-monitoring test. Endoscopy using the OE system with optical magnification was performed in all patients to detect minimal mucosal esophageal lesions (MMEL), specifically abnormalities in the numbers, dilation, and tortuosity of intrapapillary capillary loops (IPCLs). Biopsies were obtained from each esophageal segment, and diagnoses from images were compared to diagnoses of reflux and inflammation using 24-hour pH-impedance monitoring and histology, respectively. Fifty-seven patients were included (36 in the NERD group, 21 in the control group). IPCLs were observed in 94.4 % of cases in the NERD group and 38 % of cases in the control group ( < 0.05). There were significant differences in IPCL abnormalities between groups that were associated with histologically identified inflammation. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 94.4 %, 61.9 %, 80.9 %, 86.6 %, and 82.4 %, respectively. The 24-hour pH-impedance-monitoring test was used as the gold standard. The Kappa interobserver and intraobserver values were 0.85 and 0.90, respectively. The OE system with optical magnification can detect MMEL and predict NERD with high sensitivity, accuracy, and interobserver and intraobserver agreement. Presence of IPCLs highly correlates with histologically identified inflammation.
本研究的目的是评估使用光学增强（OE系统）和光学放大功能的内镜检查对非糜烂性反流病（NERD）患者反流的诊断效能。2015年9月至2016年1月进行了一项前瞻性、非随机、单盲研究。参与者有胃食管反流病（GERD）症状，并根据内镜检查结果和24小时pH阻抗监测试验被分配到NERD组或非反流病对照组。所有患者均使用带光学放大功能的OE系统进行内镜检查，以检测最小黏膜食管病变（MMEL），特别是乳头内毛细血管袢（IPCL）的数量、扩张和迂曲异常。从每个食管节段获取活检组织，并将图像诊断结果分别与使用24小时pH阻抗监测和组织学诊断的反流和炎症结果进行比较。纳入了57例患者（NERD组36例，对照组21例）。NERD组94.4%的病例和对照组38%的病例观察到了IPCL（P<0.05）。两组间IPCL异常存在与组织学确定的炎症相关的显著差异。敏感性、特异性、阳性预测值、阴性预测值和准确性分别为94.4%、61.9%、80.9%、86.6%和82.4%。24小时pH阻抗监测试验用作金标准。观察者间和观察者内的Kappa值分别为0.85和0.90。带光学放大功能的OE系统能够检测MMEL并以高敏感性、准确性以及观察者间和观察者内的一致性预测NERD。IPCL的存在与组织学确定的炎症高度相关。
