Does magnifying endoscopy improve the diagnosis of erosive esophagitis?
OBJECTIVE
Low-grade erosive esophagitis (i.e. Los Angeles grade A) is the most predominant type of esophagitis in Japan. It is unclear whether all the mucosal breaks detected by conventional endoscopy are indicative of esophageal mucosal erosion. Hospital-based, cross-sectional, cross-over, observational study was assigned to investigate the value of magnifying endoscopy for diagnosis of erosive esophagitis.


METHODS
From August to December 2006, 178 consecutive patients with upper gastrointestinal symptoms were enrolled at three university hospitals and one national medical center in western Japan. Before endoscopy, all participants were requested to answer questionnaires concerning their symptoms. Experienced endoscopists performed an endoscopic diagnosis of each patient first with a conventional standard view and then with a magnifying view. Endoscopic diagnostic concordance between conventional and magnifying endoscopic view for erosive esophagitis was calculated. Relationship between a variety of symptoms and erosive esophagitis was also evaluated.


RESULTS
Erosive esophagitis was identified using conventional and magnifying endoscopy in 14.6% and 17.4% of patients, respectively. Eleven false-negative and six false-positive diagnoses using conventional endoscopy occurred among the 178 enrolled patients. The weighted kappa value of diagnostic concordance for erosive esophagitis between the two endoscopic views was 0.76. The prevalence of erosive esophagitis in patients with reflux-, dysmotility-, and ulcer-like symptoms was 20.7%, 24.1%, and 15.2%, respectively.


CONCLUSIONS
Magnifying endoscopy did not significantly improve the diagnostic sensitivity of erosive esophagitis over non-magnifying, conventional endoscopy. Erosive esophagitis was frequently identified in patients that did not have reflux symptoms.
Amano
Yuji
Y
Division of Gastrointestinal Endoscopy, Shimane University Hospital, Izumo, Japan. amano@med.shimane-u.ac.jp
Yamashita
Haruhiro
H
Koshino
Kenji
K
Ohshima
Tadayuki
T
Miwa
Hiroto
H
Iwakiri
Ryuichi
R
Fujimoto
Kazuma
K
Manabe
Noriaki
N
Haruma
Ken
K
Kinoshita
Yoshikazu
Y
D000368:Aged; D018592:Cross-Over Studies; D003430:Cross-Sectional Studies; D015154:Esophageal Motility Disorders / Q000209:etiology / Q000473:pathology; D004941:Esophagitis / Q000150:complications / Q000473:pathology*; D004945:Esophagoscopy / Q000379:methods*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000473:pathology; D006801:Humans; D007089:Image Enhancement; D007564:Japan; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D010437:Peptic Ulcer / Q000209:etiology / Q000473:pathology; D011237:Predictive Value of Tests; D012720:Severity of Illness Index