Performance of narrow band imaging and magnification endoscopy in the prediction of therapeutic response in patients with gastroesophageal reflux disease.
BACKGROUND
Imaging-enhanced endoscopy enhances the contrast of the mucosal surface and helps in the diagnosis of gastroesophageal reflux disease. However, whether the increased detection of subtle erosive foci corresponds to the effect of acid suppression remains elusive.


OBJECTIVE
We aim to evaluate the utility of narrow band imaging with and without magnification endoscopy in the prediction of therapeutic response in patients with reflux.


METHODS
Endoscopic evaluation with conventional white light, narrow band imaging, and narrow band imaging with magnification was performed sequentially in consecutive patients with reflux. All patients received proton pump inhibitor for 14 days. Their therapeutic responses were correlated with the baseline endoscopic findings, including mucosal breaks under standard endoscopy, mucosal brownish changes under narrow band imaging, and increased and/or dilated intrapapillary capillary loops or microerosions under narrow band imaging with magnification.


RESULTS
Of a total of 82 patients, 22 (26.8%) patients were diagnosed with erosive disease under standard endoscopy. Among the remaining 60 (73.2%) patients, 14 (23.3%) and 30 (50%) were considered erosive under narrow band imaging and narrow band imaging with magnification, respectively. Sixty-five (79.3%) patients showed a positive therapeutic response. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in predicting therapeutic response were 33.8%, 100%, 100%, 28.3%, and 47.6%, respectively, for standard endoscopy; 52.3%, 88.2%, 94.4%, 32.6%, and 59.8%, respectively, for narrow band imaging; and 70.8%, 64.7%, 88.4%, 36.6%, and 69.5%, respectively, for narrow band imaging with magnification.


CONCLUSIONS
Narrow band imaging with and without magnification endoscopy substantially improve our ability to predict therapeutic response in patients with gastroesophageal reflux.
Tseng
Ping-Huei
PH
Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
Chen
Chien-Chuan
CC
Chiu
Han-Mo
HM
Liao
Wei-Chih
WC
Wu
Ming-Shiang
MS
Lin
Jaw-Town
JT
Lee
Yi-Chia
YC
Wang
Hsiu-Po
HP
D000328:Adult; D003952:Diagnostic Imaging / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology*; D011237:Predictive Value of Tests; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome
D054328:Proton Pump Inhibitors