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Abstract
Esophagitis in cats and dogs is a consequence of increased exposure of the esophageal mucosa to gastroduodenal reflux. Causes can include anesthesia-related reflux, frequent vomiting, or lodged foreign bodies. An exception is eosinophilic esophagitis, an emerging primary inflammatory disease of the esophagus with a presumed allergic etiology. Reflux esophagitis owing to lower esophageal sphincter incompetence is often suspected; a tentative diagnosis can be made by endoscopic assessment, wireless esophageal pH-monitoring, or histologic examination. Because it can be difficult to distinguish diet-responsive upper gastrointestinal disease from esophagitis, response to treatment with gastric acid suppressants is needed to confirm the tentative diagnosis.
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Affiliation(s)
- Peter Hendrik Kook
- Department of Small Animals, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, Zurich 8057, Switzerland.
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Ventrella D, Salaroli R, Elmi A, Carnevali G, Forni M, Baldi F, Bacci ML. A novel ex vivo porcine model of acid-induced esophageal damage for preliminary functional evaluations of anti-gastroesophageal reflux disease medical devices. Vet World 2020; 13:2728-2735. [PMID: 33487991 PMCID: PMC7811544 DOI: 10.14202/vetworld.2020.2728-2735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/04/2020] [Indexed: 11/29/2022] Open
Abstract
Aim The aim of the study was to set up a porcine ex vivo model of acid-induced damage and to evaluate its performance by means of multichannel intraluminal impedance and pH (MII-pH) live recording, histology, and Evans blue (EB) permeability assay. Materials and Methods Thirteen esophagi, collected at a slaughterhouse, were ablated of their sphincters, pinned upright on a support, and placed in a thermostatic hood at 37°C with two infusion tubes and an MII-pH probe inserted in the top end. Three esophagi (histology controls) were only left in the hood for 3.5 h before sampling, while the remaining organs underwent the experimental protocol including saline infusion and recovery recording, and acid solution infusion and recovery recording. Results MII-pH analysis highlighted a significantly stronger decrease during acid infusion when compared to saline, but a better post-infusion recovery for saline solution. At the end of the protocol, MII was still statistically lower than baseline. The acid-damaged esophagi significantly absorbed more EB dye, and histology revealed strong mucosal exfoliation. Conclusion The proposed model of esophageal acid damage seems to be repeatable, reliable, and achievable using organs collected at the slaughterhouse. MII recording proved to have good sensitivity in detecting mucosal alterations also in ex vivo trials.
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Affiliation(s)
- Domenico Ventrella
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (BO), Italy
| | - Roberta Salaroli
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (BO), Italy
| | - Alberto Elmi
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (BO), Italy
| | - Giacomo Carnevali
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (BO), Italy
| | - Monica Forni
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (BO), Italy
| | - Fabio Baldi
- Center for the Study of Diseases of the Esophagus, University of Bologna, Bologna, Italy.,GVM Care and Research, Cotignola (RA), Italy
| | - Maria Laura Bacci
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (BO), Italy
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Jeong E, Yoo IK, Yeniova AÖ, Yon DK, Cho JY. Confocal Laser Endomicroscopic Findings of Refractory Erosive Reflux Disease versus Non-Erosive Reflux Disease with Anti-Reflux Mucosectomy: An in vivo and ex vivo Study. Clin Endosc 2020; 54:55-63. [PMID: 32375457 PMCID: PMC7939765 DOI: 10.5946/ce.2020.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background/Aims To date, there is no standard tool to diagnose gastroesophageal reflux disease (GERD). Typically, GERD is a non-erosive reflux disease (NERD) that does not present endoscopic abnormalities. Confocal laser endomicroscopy (CLE) has been shown to be an effective tool to identify and diagnose GERD. We aimed to investigate the cellular and vascular changes in vivo and ex vivo through CLE in patients with GERD.
Methods Patients with refractory GERD who underwent mucosectomy were recruited. The distal esophagus was observed in vivo using CLE. Mucosectomy tissue was stained with acriflavine and CLE image was obtained ex vivo. We compared cellular and vascular changes in CLE between erosive reflux disease (ERD), NERD, and a control group.
Results Eleven patients who underwent anti-reflux mucosectomy and five control patients were enrolled in the study. Patients with ERD and NERD presented greater dilated intercellular space than patients in the control group on CLE image. The diameter, number, and cross-sectional area of the intra-papillary capillary loops (IPCLs) were significantly larger in the ERD group than in the NERD group. The irregular shape of the IPCLs were observed in both patients with ERD and NERD.
Conclusions The irregular shape of the IPCLs were significantly correlated with a positive diagnosis of GERD. CLE may diagnose NERD with high sensitivity and accuracy.
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Affiliation(s)
- Eunju Jeong
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
| | - In Kyung Yoo
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
| | - Abdullah Özgür Yeniova
- Division of Gastroenterology, Department of Internal Medicine, Tokat Gaziosmanpaşa University, Faculty of Medicine, Tokat, Turkey
| | - Dong Keon Yon
- Department of Pediatrics, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
| | - Joo Young Cho
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
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Galli J, Meucci D, Salonna G, Anzivino R, Giorgio V, Trozzi M, Settimi S, Tropiano ML, Paludetti G, Bottero S. Use OF NBI for the assessment of clinical signs of rhino-pharyngo-laryngeal reflux in pediatric age: Preliminary results. Int J Pediatr Otorhinolaryngol 2020; 128:109733. [PMID: 31670195 DOI: 10.1016/j.ijporl.2019.109733] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Laryngopharyngeal reflux (LPR) is a complex problem in pediatric population: diagnosis and clinical presentation are still controversial. Classic white light endoscopy shows some pathognomonic signs of LPR in children, such as thickening of pharyngo-laryngeal mucus, the cobblestoning aspect of pharyngeal mucosa, arytenoid edema/hyperemia, nodular thickening/true vocal cord edema, hypertrophy of the posterior commissure, subglottic edema. The NBI (Narrow Band Imaging) technology, generally used in oncology, allows to study neoangiogenesis and hypervascularization of the mucosa, common aspects in both chronic inflammation and neoplastic transformation. The aim of our study was to evaluate the added value of this technology in identifying the main laryngopharyngeal reflux sign in a pediatric population. METHODS We evaluated at the Otolaryngology Unit of the "Fondazione Policlinico A. Gemelli" hospital and the Airway Surgery Unit of the "Bambino Gesù" Children's Hospital 35 patients aged from 2 months to 16 years divided into two groups in the period between November 2017 and May 2018. Group A included patients with clinical suspicion of LPR after gastroenterologist evaluation and Group B included patients who underwent an endoscopic evaluation for the assessment of recurrent respiratory symptoms such as stridor, recurrent croup, wheezing and persistent cough. We performed an endoscopic evaluation by white light and NBI for each patient, comparing the results of both methods to evaluate signs of pharyngo-laryngeal reflux and to calculate the value of reflux finding score (RFS). RESULTS The analysis of the data showed: for Group A an average value of RFS with white light of 11,84 (range 8-17, standard deviation 2,52 ± 0,57) and with NBI of 13,63 (range 10-17, standard deviation 2,13 ± 0,49); for Group B the analysis of the data showed an average value of RFS with white light of 10,06 (range 8-14, standard deviation 2,32 ± 0,58) and with NBI of 12,50 (range 9-18, standard deviation 2,63 ± 0,65). The comparison between the two methods resulted significant. Furthermore evaluation by NBI allowed to highlight other signs of pharyngo-laryngeal reflux, characteristic of pediatric age and not included in RFS, in particular cobblestone aspect of the hypopharingeal mucosa, phlogosis of the tonsillar crypts and adenoid surface, hyperemia and hypervascularization of subglottic and tracheal mucosa. CONCLUSION Although still preliminary our results represent an interesting starting point for further studies, because they underline the potentiality of NBI endoscopy in LPR evaluation and how this technology could improve the identification of reflux signs.
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Affiliation(s)
- J Galli
- Department of Head and Neck Surgery - Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - D Meucci
- Airway Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
| | - G Salonna
- Department of Head and Neck Surgery - Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - R Anzivino
- Airway Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - V Giorgio
- Department of Pediatrics, Catholic University School of Medicine and Surgery, Rome, Italy
| | - M Trozzi
- Airway Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - S Settimi
- Department of Head and Neck Surgery - Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - M L Tropiano
- Airway Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - G Paludetti
- Department of Head and Neck Surgery - Institute of Otorhinolaryngology, Catholic University School of Medicine and Surgery, Rome, Italy
| | - S Bottero
- Airway Surgery Unit, Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy
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Robles-Medranda C, Valero M, Soria-Alcívar M, Puga-Tejada M, Oleas R, Ospina J, Alvarado-Escobar H, Baquerizo-Burgos J, Pitanga-Lukashok H. Detection of minimal mucosal esophageal lesions in non-erosive gastroesophageal reflux disease using optical enhancement plus optical magnification. Endosc Int Open 2019; 7:E979-E986. [PMID: 31367678 PMCID: PMC6656555 DOI: 10.1055/a-0953-1844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/16/2019] [Indexed: 01/15/2023] Open
Abstract
Background and study aims 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. Patients and methods 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. Results 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 ( P < 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. Conclusion 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.
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Affiliation(s)
- Carlos Robles-Medranda
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador,Corresponding author Carlos Robles-Medranda, MD Head of the Endoscopy DivisionInstituto Ecuatoriano de Enfermedades Digestivas – IECEDAv. Abel Romeo Castillo y Av. Juan Tanca MarengoTorre Vitalis, Mezzanine 3GuayaquilEcuador+59342109180
| | - Manuel Valero
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Miguel Soria-Alcívar
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Miguel Puga-Tejada
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Roberto Oleas
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Jesenia Ospina
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Haydee Alvarado-Escobar
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Jorge Baquerizo-Burgos
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Hannah Pitanga-Lukashok
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
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Dobashi A, Goda K, Furuhashi H, Matsui H, Hara Y, Kamba S, Kobayashi M, Sumiyama K, Hirooka S, Hamatani S, Rajan E, Ikegami M, Tajiri H. Diagnostic efficacy of dual-focus endoscopy with narrow-band imaging using simplified dyad criteria for superficial esophageal squamous cell carcinoma. J Gastroenterol 2019; 54:501-510. [PMID: 30406847 DOI: 10.1007/s00535-018-1527-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/26/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Our previous studies have shown the diagnostic utility of a newly developed dual-focus endoscope with narrow-band imaging (DF-NBI) and simplified dyad criteria for detection of superficial esophageal squamous cell carcinoma (SESCC). This clinical trial aimed to study the diagnostic efficacy of DF-NBI with dyad criteria for detecting SESCC compared to white light imaging (WLI). METHODS This was a single-arm prospective comparative trial. We enrolled 170 consecutive high-risk patients for esophageal squamous cell carcinoma. Patients were initially examined with WLI by one independent endoscopist and then the other performed DF-NBI blinded to the WLI diagnosis to avoid a carry-over effect. Lesions showing proliferation and/or various shapes of intrapapillary capillary loops (IPCL) under DF-NBI (i.e., dyad criteria) were endoscopically diagnosed as SESCC including high-grade intraepithelial neoplasia. The primary endpoint was sensitivity of WLI and DF-NBI for detecting SESCC. The secondary endpoints were the diagnostic performance (i.e., specificity and accuracy) and inter/intra-observer concordance of DF-NBI with dyad criteria. RESULTS A total 77 SESCCs were detected. The sensitivity of DF-NBI for SESCC was significantly higher than that of WLI (91% vs. 51%, P < 0.001). The specificity and accuracy of WLI and DF-NBI using dyad criteria were 100% vs. 84%, and 86% vs. 86%, respectively. Various shapes and proliferation of IPCL showed the highest value in inter-observer and intra-observer agreements (κ = 0.77 and 0.82, respectively). CONCLUSION DF-NBI combined with dyad criteria may be a promising technique with a high sensitivity for diagnosis of SESCC and high inter/intra-observer agreement.
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Affiliation(s)
- Akira Dobashi
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan. .,Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
| | - Kenichi Goda
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.,Department of Gastroenterology, Dokkyo Medical University, Mibu, Japan
| | - Hiroto Furuhashi
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroaki Matsui
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuko Hara
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Shunsuke Kamba
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Masakuni Kobayashi
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuki Sumiyama
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinichi Hirooka
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shigeharu Hamatani
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Elizabeth Rajan
- Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Masahiro Ikegami
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hisao Tajiri
- Department of Innovative Interventional Endoscopy Research, The Jikei University School of Medicine, Tokyo, Japan
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Wasielica-Berger J, Kemona A, Kiśluk J, Świdnicka-Siergiejko A, Rogalski P, Chwieśko A, Kostrzewska M, Dąbrowski A. The added value of magnifying endoscopy in diagnosing patients with certain gastroesophageal reflux disease. Adv Med Sci 2018; 63:359-366. [PMID: 30114679 DOI: 10.1016/j.advms.2018.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 04/09/2018] [Accepted: 04/26/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE In most cases gastroesophageal reflux disease proceeds without macroscopic erosions in the esophagus. We aimed to clarify if abnormalities detectable in magnifying endoscopy may offer additional diagnostic criteria for gastroesophageal reflux disease and to what histopathologic structures do they correspond. PATIENTS/METHODS Esophageal mucosa above and below Z-line was evaluated under x115 magnification in 67 gastroesophageal reflux disease patients (11 with erosive reflux disease, 28 with Barrett's esophagus, 28 with nonerosive reflux disease) and in 12 patients without gastroesophageal reflux disease (negative control group). Features characteristic of gastroesophageal reflux disease were specified by comparing erosive reflux disease and Barrett's esophagus patients with negative control group. Afterwards the presence of identified features were evaluated in nonerosive reflux disease group. Interobserver agreement in the recognition of the proposed criteria was rated. Biopsies collected from the mucosa above Z-line were evaluated histologically after hematoxylin and eosin staining. RESULTS Endoscopic lesions characteristic of gastroesophageal reflux disease were: microerosions, abnormal intrapapillary capillary loops, obscured palisade vessels, white points, big triangular indentations of Z-line and villous mucosa below Z-line. The presence of two or more of the above features indicated gastroesophageal reflux disease with 97% sensitivity and 75% specificity. Substantial interobserver agreement was achieved in evaluation of obscured palisade vessels, abnormal intrapapillary capillary loops and white points. Endoscopic lesions were correlated to histology. Lesions identified with magnifying endoscopy were helpful in discerning between negative control group and nonerosive reflux disease patients. CONCLUSIONS Magnifying endoscopy reveals abnormalities that can be used as additional endoscopic diagnostic criteria of gastroesophageal reflux disease.
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Parikh ND, Viana AV, Shah S, Laine L. Image-enhanced endoscopy is specific for the diagnosis of non-erosive gastroesophageal reflux disease. Scand J Gastroenterol 2018; 53:260-264. [PMID: 29368532 PMCID: PMC6080852 DOI: 10.1080/00365521.2018.1430847] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES We assessed the performance characteristics of image-enhanced endoscopy with i-Scan or narrow band imaging (NBI) in patients with non-erosive gastroesophageal reflux disease (GERD) compared to controls without heartburn. MATERIAL AND METHODS Image-enhanced endoscopic findings of vascularity at the squamocolumnar junction, distal esophageal micro-erosions, and non-round pit pattern at the squamocolumnar junction were assessed in cases (heartburn not responsive to PPIs, positive results on validated GERD questionnaire, no esophageal erosions, esophageal biopsies with histologic evidence of GERD (basal cell hyperplasia, elongation of papillae and dilation of intercellular spaces all required)) and in controls (no GERD symptoms or esophageal erosions). RESULTS Twenty cases and 60 controls were compared. The pre-defined features were more common in cases vs. CONTROLS vascularity RR = 4.9 (95% CI: 2.4-10.0), specificity = 86.7%; micro-erosions RR = 9.7 (3.6-26.5), specificity = 93.3%; non-round pit pattern RR = 2.4 (1.7-3.3), specificity = 60.0%; combination of vascularity and micro-erosions RR = 30.0 (4.1-220), specificity = 98.3%. These differences were consistent with both i-Scan and NBI. CONCLUSIONS Image-enhanced endoscopic findings of vascularity and micro-erosions were very specific for non-erosive GERD. Image-enhanced endoscopy may be useful in real-time diagnosis of non-erosive GERD when patients undergo upper endoscopy for heartburn. The relative utility of image-enhanced endoscopy vs. pH-impedance monitoring, based on efficacy, cost and patient acceptance, requires additional study.
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Affiliation(s)
- Neil D. Parikh
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT,VA Connecticut Healthcare System, West Haven, CT
| | - Artur V. Viana
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT,VA Connecticut Healthcare System, West Haven, CT
| | | | - Loren Laine
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT,VA Connecticut Healthcare System, West Haven, CT
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9
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Wang WH, Tsai KY. Narrow-Band Imaging of Laryngeal Images and Endoscopically Proven Reflux Esophagitis. Otolaryngol Head Neck Surg 2015; 152:874-80. [PMID: 25628366 DOI: 10.1177/0194599814568285] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 12/23/2014] [Indexed: 12/14/2022]
Abstract
Objective To compare the difference between white light (WL) and narrow-band imaging (NBI) endoscopy in evaluating patients who had reflux laryngitis and esophagitis. Study Design Retrospective review of medical records and endoscopic images. Setting Outpatient clinic. Subjects and Methods There were 102 consecutive patients with reflux esophagitis (mean age, 48 ± 11 years) who had office-based transnasal esophagoscopy (TNE) with WL and NBI views, including 60 men (59%) and 42 women (41%). We compared WL and NBI endoscopy in observing the laryngeal and esophageal epithelium. The nasopharynx, base of the tongue, epiglottis, hypopharynx, larynx, esophagus, gastroesophageal junction, and stomach were examined, and all procedures were digitally recorded. All patients were evaluated with WL and NBI views to determine the reflux finding score (RFS) in the larynx and Los Angeles (LA) classification grade in the esophagus. Results The NBI views were more sensitive than the WL views in the erythema/hyperemia, vocal cord edema, and global RFS scores. The NBI view facilitated the identification of the erythema/hyperemia change representing dilation or proliferation of microvessels caused by epithelial inflammation. The global RFS score was significantly associated with severity of LA grade only with the NBI view. Conclusion The endoscopic findings with the NBI view permit an easier identification of the RFS parameters of laryngeal erythema/vocal cord edema, which have a stronger correlation with the severity of reflux esophagitis, than the WL view. The importance of NBI in the evaluation of reflux laryngitis and gastroesophageal reflux disease deserves further study.
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Affiliation(s)
- Wen-Hung Wang
- Department of Otolaryngology, Cathay General Hospital, Taipei, Taiwan, Republic of China
- Department of Otolaryngology, Sijhih Cathay General Hospital, New Taipei City, Taiwan, Republic of China
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, Republic of China
| | - Kai-Yu Tsai
- Department of Otolaryngology, Cathay General Hospital, Taipei, Taiwan, Republic of China
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