Linked color imaging improves visibility of reflux esophagitis

BMC Gastroenterology

Yuta Nakagawa¹  Yoshihiro Inami¹  Hitoshi Sasaki¹  Daisuke Asaoka¹  Maiko Suzuki¹  Kenshi Matsumoto²  Akihito Nagahara²  Hisanori Utsunomiya²  Taro Osada²  Hiroyuki Komori²  Kohei Matsumoto²  Atsushi Ikeda²  Yoichi Akazawa²  Kumiko Ueda²  Shotaro Oki²  Mariko Hojo²  Nobuyuki Suzuki²  Tsutomu Takeda²  Daiki Abe²  Noboru Yatagai²  Hiroya Ueyama²  Yuji Shimada²  Muneo Ikemura²  Shuko Nojiri³ 

[1] Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan;Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421, Tokyo, Japan;Department of Medical Technology Innovation Center, Juntendo University School of Medicine, Tokyo, Japan;

关键词: Reflux esophagitis;    Linked color imaging;    Blue LASER imaging;    Visibility;    Inter-rater reliability;    Color difference;   

DOI  :  10.1186/s12876-020-01511-9

来源: Springer

【 摘 要 】

BackgroundWith 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).MethodsConsecutive 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.ResultsThe 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).ConclusionLCI 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.

【 授权许可】

CC BY