Abe Yasuhiko, Sasaki Yu, Yagi Makoto, Mizumoto Naoko, Onozato Yusuke, Kon Takashi, Shoji Masakuni, Sakuta Kazuhiro, Sakai Takayuki, Umehara Matsuki, Ito Minami, Nakamura Shuhei, Tsuchida Hidemoto, Ueno Yoshiyuki
Division of Endoscopy Yamagata University Hospital Yamagata Japan.
Department of Gastroenterology Faculty of Medicine Yamagata University Yamagata Japan.
DEN Open. 2022 Jul 25;3(1):e146. doi: 10.1002/deo2.146. eCollection 2023 Apr.
To assess the usefulness of linked color imaging (LCI), a recently developed image-enhanced endoscopy technique, in the endoscopic diagnosis of eosinophilic esophagitis (EoE).
Thirty white light images (WLIs) and 30 WLI+LCI images collected from patients with and without EoE were randomly and blindly reviewed by 10 endoscopists, including four experts (Exs) and six non-Exs. Edema, ring, exudate furrows, and strictures were rated on the adjusted EoE endoscopic reference score; the diagnosis of EoE was assessed. Using the kappa value, inter- and intra-observer agreements were analyzed among endoscopists.
WLI+LCI images had a higher diagnostic accuracy for EoE than WLIs (0.85 vs. 0.70, respectively), especially in non-Exs or endoscopists with no experience with EoE patients. Inter-observer agreement for WLI+LCI images statistically surpassed WLIs for furrows (kappa, 0.73 vs. 0.67, respectively; = 0.0013), stricture (kappa, 0.51 vs. 0.39, respectively; = 0.0072), and diagnosis (kappa, 0.67 vs. 0.57, respectively; < 0.0001) of EoE. The increase in inter-observer agreement in WLI+LCI images allowed for a reduction in the differences between the Exs and non-Ex endoscopists. Intra-observer agreement for WLI+LCI images surpassed WLIs for a ring (kappa, 0.62 vs. 0.43, = 0.0052), and a similar trend was found in exudates, furrows, and diagnosis irrespective of the Exs or non-Exs.
LCI can contribute to the improvement of the endoscopic diagnosis for EoE, with "moderate" to "substantial" consistency, by enhancing the visibility of abnormal findings, leading to reduced diagnostic disparities among endoscopists.
评估一种最近开发的图像增强内镜技术——联动成像（LCI）在嗜酸性食管炎（EoE）内镜诊断中的效用。
10名内镜医师（包括4名专家和6名非专家）对从有或无EoE患者收集的30张白光图像（WLI）和30张WLI + LCI图像进行随机、盲法评估。根据调整后的EoE内镜参考评分对水肿、环、渗出沟和狭窄进行评分；评估EoE的诊断。使用kappa值分析内镜医师之间的观察者间和观察者内一致性。
WLI + LCI图像对EoE的诊断准确性高于WLI（分别为0.85和0.70），特别是在非专家或无EoE患者诊断经验的内镜医师中。对于EoE的沟（kappa分别为0.73和0.67；P = 0.0013）、狭窄（kappa分别为0.51和0.39；P = 0.0072）和诊断（kappa分别为0.67和0.57；P < 0.0001），WLI + LCI图像的观察者间一致性在统计学上超过WLI。WLI + LCI图像观察者间一致性的提高使专家和非专家内镜医师之间的差异减小。对于环（kappa分别为0.62和0.43；P = 0.0052），WLI + LCI图像的观察者内一致性超过WLI，并且在渗出物、沟和诊断方面，无论专家或非专家，都发现了类似趋势。
LCI通过增强异常发现的可见性，可提高EoE的内镜诊断水平，具有“中等”至“高度”的一致性，从而减少内镜医师之间的诊断差异。
