Tsutomu Takeda1, Daisuke Asaoka2, Daiki Abe1, Maiko Suzuki2, Yuta Nakagawa2, Hitoshi Sasaki2, Yoshihiro Inami2, Muneo Ikemura1, Hisanori Utsunomiya1, Shotaro Oki1, Nobuyuki Suzuki1, Atsushi Ikeda1, Noboru Yatagai1, Hiroyuki Komori1, Yoichi Akazawa1, Kohei Matsumoto1, Kumiko Ueda1, Hiroya Ueyama1, Yuji Shimada1, Kenshi Matsumoto1, Mariko Hojo1, Taro Osada1, Shuko Nojiri3, Akihito Nagahara1
BMC Gastroenterol. 2020 Oct 27;20(1):356. doi: 10.1186/s12876-020-01511-9.
Background: 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).
Methods: 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.
Results: 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).
Conclusion: 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.
1 Department of Gastroenterology, Juntendo University School of Medicine,2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
2 Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan.
3 Department of Medical Technology Innovation Center, Juntendo University School of Medicine, Tokyo, Japan.