Takeda Tsutomu, Asaoka Daisuke, Abe Daiki, Suzuki Maiko, Nakagawa Yuta, Sasaki Hitoshi, Inami Yoshihiro, Ikemura Muneo, Utsunomiya Hisanori, Oki Shotaro, Suzuki Nobuyuki, Ikeda Atsushi, Yatagai Noboru, Komori Hiroyuki, Akazawa Yoichi, Matsumoto Kohei, Ueda Kumiko, Ueyama Hiroya, Shimada Yuji, Matsumoto Kenshi, Hojo Mariko, Osada Taro, Nojiri Shuko, Nagahara Akihito
Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan.
BMC Gastroenterol. 2020 Oct 27;20(1):356. doi: 10.1186/s12876-020-01511-9.
With more prevalent gastroesophageal reflux disease comes increased cases of Barrett's esophagus and esophageal adenocarcinoma. Image-enhanced endoscopy using linked-color imaging (LCI) differentiates between mucosal colors. We compared LCI, white light imaging (WLI), and blue LASER imaging (BLI) in diagnosing reflux esophagitis (RE).
Consecutive RE patients (modified Los Angeles [LA] classification system) who underwent esophagogastroduodenoscopy using WLI, LCI, and BLI between April 2017 and March 2019 were selected retrospectively. Ten endoscopists compared WLI with LCI or BLI using 142 images from 142 patients. Visibility changes were scored by endoscopists as follows: 5, improved; 4, somewhat improved; 3, equivalent; 2, somewhat decreased; and 1, decreased. For total scores, 40 points was considered improved visibility, 21-39 points was comparable to white light, and < 20 points equaled decreased visibility. Inter- and intra-rater reliabilities (Intra-class Correlation Coefficient [ICC]) were also evaluated. Images showing color differences (ΔE*) and L* a* b* color values in RE and adjacent esophageal mucosae were assessed using CIELAB, a color space system.
The mean age of patients was 67.1 years (range: 27-89; 63 males, 79 females). RE LA grades observed included 52 M, 52 A, 24 B, 11 C, and 3 D. Compared with WLI, all RE cases showed improved visibility: 28.2% (40/142), LA grade M: 19.2% (10/52), LA grade A: 34.6% (18/52), LA grade B: 37.5% (9/24), LA grade C: 27.3% (3/11), and LA grade D: 0% (0/3) in LCI, and for all RE cases: 0% in BLI. LCI was not associated with decreased visibility. The LCI inter-rater reliability was "moderate" for LA grade M and "substantial" for erosive RE. The LCI intra-rater reliability was "moderate-substantial" for trainees and experts. Color differences were WLI: 12.3, LCI: 22.7 in LA grade M; and WLI: 18.2, LCI: 31.9 in erosive RE (P < 0.001 for WLI vs. LCI).
LCI versus WLI and BLI led to improved visibility for RE after subjective and objective evaluations. Visibility and the ICC for minimal change esophagitis were lower than for erosive RE for LCI. With LCI, RE images contrasting better with the surrounding esophageal mucosa were more clearly viewed.
随着胃食管反流病愈发普遍，巴雷特食管和食管腺癌的病例也在增加。使用联动成像（LCI）的图像增强内镜检查可区分黏膜颜色。我们比较了LCI、白光成像（WLI）和蓝色激光成像（BLI）在诊断反流性食管炎（RE）中的效果。
回顾性选取2017年4月至2019年3月间连续接受WLI、LCI和BLI食管胃十二指肠镜检查的RE患者（改良洛杉矶[LA]分类系统）。10位内镜医师使用142例患者的142张图像比较WLI与LCI或BLI。内镜医师对可见度变化的评分如下：5分，改善；4分，有所改善；3分，相当；2分，有所下降；1分，下降。总分方面，40分被认为可见度改善，21 - 39分与白光相当，低于20分则表示可见度下降。还评估了评分者间和评分者内的可靠性（组内相关系数[ICC]）。使用CIELAB颜色空间系统评估RE及相邻食管黏膜中显示颜色差异（ΔE*）和Lab*颜色值的图像。
患者的平均年龄为67.1岁（范围：27 - 89岁；男性63例，女性79例）。观察到的RE LA分级包括52例M级、52例A级、24例B级、11例C级和3例D级。与WLI相比，所有RE病例的可见度均有改善：LCI中为28.2%（40/142），M级LA：19.2%（10/52），A级LA：34.6%（18/52），B级LA：37.5%（9/24），C级LA：27.3%（3/11），D级LA：0%（0/3）；BLI中所有RE病例的可见度改善率为0%。LCI与可见度下降无关。LCI在M级LA的评分者间可靠性为“中等”，在糜烂性RE中为“高度”。LCI在实习生和专家中的评分者内可靠性为“中等 - 高度”。颜色差异方面，M级LA中WLI为12.3，LCI为22.7；糜烂性RE中WLI为18.2，LCI为31.9（WLI与LCI比较，P < 0.001）。
主观和客观评估后，LCI与WLI和BLI相比提高了RE的可见度。LCI对于轻度变化食管炎的可见度和ICC低于糜烂性RE。使用LCI时，与周围食管黏膜对比更好的RE图像更清晰。
