Gastroenterology Department, Lyell McEwin Hospital (Northern Adelaide Local Health Network), Australia.
School of Medicine, University of Adelaide, Australia.
Singapore Med J. 2019 Oct;60(10):522-525. doi: 10.11622/smedj.2019131.
Narrow-band imaging with magnification endoscopy (NBI-ME) allows real-time visual assessment of the mucosal surface and vasculature of the gastrointestinal tract. This study aimed to determine the performance of NBI-ME combined with the water immersion technique (NBI-ME-WIT) in detecting villous atrophy.
All patients who underwent gastroscopy were included. The duodenum was further examined with NBI-ME-WIT only after examination with white light endoscopy did not reveal a cause of anaemia or dyspepsia. Targeted biopsies were taken of visualised areas. NBI-ME-WIT findings were compared with the final histopathological analysis. We calculated the sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of NBI-ME-WIT in detecting villous atrophy and the hypothetical cost saved by using a biopsy-avoiding approach.
124 patients (83 female) with a mean age of 46 (range 18-82) years were included. The most common indication for gastroscopy was abdominal pain (39%), followed by anaemia (35%), chronic diarrhoea/altered bowel habits (19%) and dyspepsia (6%). NBI-ME-WIT was able to detect all nine patients with villous atrophy - eight patchy and one total villous atrophy. The Sn, Sp, PPV and NPV of NBI-ME-WIT in detecting villous atrophy were 100.0%, 99.1%, 90.0% and 100.0%, respectively. Taking into account the cost of biopsy forceps (AUD 17) and pathology (AUD 140), this biopsy-avoidance strategy could have saved AUD 18,055 in these patients.
NBI-ME-WIT is a specific and sensitive tool to recognise and accurately diagnose villous atrophy. Biopsies can be avoided in patients with normal-sized villi, which may decrease the overall cost of the procedure.
窄带成像放大内镜（NBI-ME）可实时评估胃肠道黏膜表面和血管。本研究旨在评估水浸式窄带成像放大内镜（NBI-ME-WIT）检测绒毛萎缩的性能。
所有接受胃镜检查的患者均纳入研究。白光内镜检查未发现贫血或消化不良的病因后，进一步用 NBI-ME-WIT 检查十二指肠。对可见区域进行靶向活检。将 NBI-ME-WIT 结果与最终的组织病理学分析进行比较。我们计算了 NBI-ME-WIT 检测绒毛萎缩的灵敏度（Sn）、特异性（Sp）、阳性预测值（PPV）和阴性预测值（NPV），以及采用避免活检方法可节省的假设成本。
共纳入 124 例（83 例女性）患者，平均年龄 46 岁（18-82 岁）。最常见的胃镜检查指征为腹痛（39%），其次为贫血（35%）、慢性腹泻/排便习惯改变（19%）和消化不良（6%）。NBI-ME-WIT 能够检测到所有 9 例绒毛萎缩患者 - 8 例为斑片状，1 例为全部绒毛萎缩。NBI-ME-WIT 检测绒毛萎缩的 Sn、Sp、PPV 和 NPV 分别为 100.0%、99.1%、90.0%和 100.0%。考虑活检钳（17 澳元）和病理（140 澳元）的成本，该活检避免策略可在这些患者中节省 18055 澳元。
NBI-ME-WIT 是一种识别和准确诊断绒毛萎缩的特异性和敏感性工具。对于绒毛大小正常的患者，可以避免进行活检，从而可能降低整体治疗费用。
