High-definition endoscopy with i-Scan and Lugol's solution for more precise detection of mucosal breaks in patients with reflux symptoms.
OBJECTIVE
Patients with gastroesophageal reflux disease are subdivided into non-erosive (NERD) and erosive reflux disease (ERD). The newly available EPKi processor enables high-definition resolution above HDTV standard (HD+). The aim of the study was to test the efficacy of HD+ esophagogastroduodenoscopy alone and in conjunction with i-Scan (newly developed postprocessing digital filter) and chromoendoscopy (Lugol's solution) for differentiation of reflux patients.


METHODS
The distal esophagus of patients with heartburn was inspected with three imaging modalities. HD+ was followed by i-Scan and 15-mL Lugol's solution (1.5 %). The esophagus was evaluated for mucosal breaks (Los Angeles Classification [LA]). Small visible changes were also characterized, and targeted biopsies were performed. End points of the study were the presence and grade of esophagitis and the number of circumscribed changes.


RESULTS
A total of 50 patients were included (female 29; mean age 54.7 years). HD+ identified nine patients with mucosal breaks (LA 7A; 2C), i-Scan was able to detect 12 patients (LA 8A; 2B; 2C; 0D) ( P = n. s.) and chromoendoscopy identified 25 patients (LA 16A; 7B; 1C, 1D) ( P < 0.01). Furthermore, a higher grade of esophagitis was recognized by using i-Scan and Lugol's solution in 19 patients. The number of circumscribed lesions could be increased from 21 (HD+) to 58 (i-Scan) ( P < 0.01), and up to 85 after Lugol spraying ( P < 0.01).


CONCLUSIONS
Lugol's solution in conjunction with HD+ endoscopy significantly improves the identification of patients with esophagitis and reduces misclassification. The i-Scan filter and chromoendoscopy help to identify reflux-associated lesions.
Hoffman
A
A
I Med Clinic, Johannes Gutenberg University Mainz, Germany. AHoff66286@aol.com
Basting
N
N
Goetz
M
M
Tresch
A
A
Mudter
J
J
Biesterfeld
S
S
Galle
P R
PR
Neurath
M F
MF
Kiesslich
R
R
D004396:Coloring Agents; D016145:Endoscopy, Digestive System / Q000379:methods*; D004942:Esophagitis, Peptic / Q000209:etiology / Q000473:pathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007454:Iodides; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies
D004396:Coloring Agents; D007454:Iodides; C010389:Lugol's solution