Su2018 Pentax I-SCAN™ With Magnification for the Identification of Underdiagnosis Organic Esophageal Lesions (Barret Esophagus and Esophagitis) in Patients With Functional Dyspepsia: A Prospective Study

Robles-Medranda, Carlos; Valle, Raquel S. Del; ALcívar, Miguel Soria; Velez, Gladys Bravo; Rendón, Francisco Abarca; Robles-Jara, Carlos

doi:10.1016/s0016-5085(14)61897-7

Cited by 2 publications

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“…In agreement with our study, Medranda et al found that 80% of patients who showed evidence of esophogitis at I-SCAN had HPRE and 20 % had normal epithelium. 28 In the current study, 52% of the patients who had no mucosal breaks on WLE showed evidence of minimal change esophogitis by I-SCAN 2 and HPRE .Chu et al found that I-SCAN detected more minimal changes in NERD patients than functional heartburn (FH) and the control group and that pathologic changes related to acid reflux were found in NERD patients but not in patients with FH and control subjects. 29 This denotes that I-SCAN can help in distinguishing NERD patients from those with FH without the need for further diagnostic tests.…”

Section: Discussionsupporting

confidence: 43%

The validity of I-Scan in diagnosis of gastroesophageal reflux disease

Mohammed Saad,

EL-Moniem,

Ibrahim

et al. 2023

GHOA

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Background: The evaluation of patients with suspected gastroesophageal reflux disease (GERD) frequently represents a diagnostic dilemma. Confirmation of the presence of the esophogeal mucosal injury is one of the roles of endoscopy in GERD diagnosis. In this context, there are limitations of white light endoscopy (WLE) because of the inadequate visualization of the minute mucosal changes and the uncertainty in describing the severity of mucosal injury. I-SCAN technology helps in revealing fine details of the GI mucosa. Aim: to evaluate the diagnostic efficacy of I-SCAN technology as compared to white light endoscopy (WLE) in Egyptian patients suffering from GERD symptoms. Patients and methods: This study included adult patients with GERD questionnaire (Q) score ≥ 8 points. The distal esophagus was examined by WLE followed by I-SCAN 2 to evaluate the presence of mucosal injuries and to classify GERD severity according to the Los Angles (LA) classification & its Japanese modification, respectively. Biopsies were taken from the lower esophageal mucosa as well as from the visible mucosal breaks and subjected to histopathologic examination. Results: Sixty patients were enrolled; 32 (53.3%) were females & 28 (46.7%) were males. WLE showed erosive reflux disease (ERD) in 41 patients (68.3%); while 19 patients (31.7%) showed no mucosal breaks. As regard LA classification; 18 of the cases were classified as grade A (30%); 15 as grade B (25%); 7 as grade C (11.7%) and 1 as grade D (1.7%). Reexamination of distal esophagus by I-SCAN 2 showed minimal change esophagitis (MCE) (grade M) & ERD in 57 patients (95%); while only 3 patients (5%) showed no mucosal changes (grade N). As regard the modified LA classification; 16 cases were classified as grade M (26.6%); 12 as grade A (20%); 21 as grade B (35%); 7 as grade C (11.7%) and 1 as grade D (1.7%). There was perfect agreement of WLE with I-SCAN 2 in LA grades B, C & D. There was poor agreement of WLE with I-SCAN 2 in cases who had no mucosal breaks & LA grade A cases on WLE (weighted Kappa was 0.11); as 16 cases were reclassified as grade M on I-SCAN 2 (had no mucosal breaks on WLE) and 6 cases were reclassified as class B on I-SCAN 2(were classified as grade A on WLE). As regard the histological proven reflux esophagitis (HPRE), it was present in 41 (68.3%) of the studied cases with statistically significant higher proportion of male gender. It was present in 28 (68.3%) of the patients who had ERD on WLE; 13(68.4%) of the patients who had no mucosal breaks on WLE; 38 (66.6%) of the cases who had grade M or ERD on I-SCAN 2 & the three patients who had grade N on I-SCAN 2.GERD Q score ranged from 10 to 12 points with median of 11 points. It was significantly higher in patients with HPRE (11.4 ± 1.8 points) than those without (10.3 ± 1.3 points) (p= 0.026). GERD Q score strongly correlated with both the modified LA grade by I-SCAN 2 (p=0.03) and the histological severity score (p=0,016). On univariate & multivariate analysis, male gender and GERD Q score > 11points were significant predictors of HPRE (p < .001). ROC analysis curve showed that GERD Q score at a cut-off > 11points was a significant predictor of HPRE with a sensitivity of 47%, specificity of 85%, AUC of 66.7% and p = 0.015. Conclusion: I-SCAN technology may improve the diagnosis of the esophogeal mucosal injury in GERD patients. There was poor agreement of WLE with I-SCAN 2 in patients who had no mucosal breaks & those with LA grade A on WLE. However, there was perfect agreement of WLE with I-SCAN 2 in patients with LA grades B, C& D. GERD Q score had positive correlation with both the modified LA grade on I-SCAN 2 and the histological severity score. Male gender and GERD Q score > 11points were significant predictors of histological proven reflux esophagitis.

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Section: Discussionsupporting

confidence: 43%

The validity of I-Scan in diagnosis of gastroesophageal reflux disease

Mohammed Saad,

EL-Moniem,

Ibrahim

et al. 2023

GHOA

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“…Alterations such as punctuate erythema located above the Z-line are typically classified as caused by NERD, but the sensitivity for their detection is low (64 %), and the interobserver consistency displays poor agreement 25 . I-scan is useful for detecting Barrett’s esophagus and reflux esophagitis 7 . Netinatsunton et al used I-scan to detect minimal change esophagitis (minute erosion, punctuate erythema and elongated pit pattern of gastric mucosa with triangular lesions); however, low sensitivity and PPV were described 8 .…”

Section: Discussionmentioning

confidence: 99%

“…We then performed a conventional complete endoscopic procedure that reached the Z-line of the esophagus, and evaluated the entire esophagus (upper, middle and lower segments) initially using high-definition WLE, followed by digital chromoendoscopy (I-SCAN Pentax, Tokyo, Japan) with three different image algorithms, including I-scans 1, 2 and 3 (tone and enhancement filters), that accurately detects erosive reflux, short Barret’s esophagus and minimal change esophagitis (MCE) 7 11 . Presence of reflux lesions, such as ulcerative esophagitis, esophageal strictures, Barrett’s esophagus or any erosive sign according to the Los Angeles classification (grade A to D ) as well as MCE, was considered sufficient to classify patients as having erosive GERD, and they patients were excluded from the protocol 12 .…”

Section: Methodsmentioning

confidence: 99%

“…Previous studies using virtual chromoendoscopy with I-SCAN with high-definition technology have shown that this technique improves diagnosis of erosive reflux disease by 30 %, allowing detection of small inflammatory changes (short erosions or short Barrett’s esophagus) that were not previously detected by standard endoscopy 6 7 . Nevertheless, I-SCAN can detect minimal mucosal esophageal lesions (MMEL).…”

Section: Introductionmentioning

confidence: 99%

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Detection of minimal mucosal esophageal lesions in non-erosive gastroesophageal reflux disease using optical enhancement plus optical magnification

et al. 2019

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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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Su2018 Pentax I-SCAN™ With Magnification for the Identification of Underdiagnosis Organic Esophageal Lesions (Barret Esophagus and Esophagitis) in Patients With Functional Dyspepsia: A Prospective Study

Cited by 2 publications

References 0 publications

The validity of I-Scan in diagnosis of gastroesophageal reflux disease

The validity of I-Scan in diagnosis of gastroesophageal reflux disease

Detection of minimal mucosal esophageal lesions in non-erosive gastroesophageal reflux disease using optical enhancement plus optical magnification

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