Linked color imaging improves detection of minimal change esophagitis in non-erosive reflux esophagitis patients

Pei Deng, Min Min, Tenghui Dong, Yiliang Bi, Airong Tang, Yan Liu, Pei Deng, Min Min, Tenghui Dong, Yiliang Bi, Airong Tang, Yan Liu

Abstract

Background and study aims Non-erosive reflux disease (NERD) includes minimal change esophagitis (MCE) and no endoscopic abnormalities. However, for most endoscopists, it is difficult to detect MCE with conventional white-light endoscopy (WLE). Linked color imaging (LCI) technology is the most recently developed image-enhancing technology and improves detection and differentiation of subtle mucosal changes using a color contrast method. This study assessed the efficacy of WLE combined with LCI for diagnosing MCE compared with WLE. Patients and methods Between February and May 2017, 44 NERD patients and 40 healthy subjects were enrolled in our study. First, the distal esophagus was examined using WLE followed by LCI. Second, three experienced endoscopists observed all the patients' white-light (WL) images and corresponding images of WL and LCI and then recorded presence or absence of minimal change esophagitis (MCE +/-). The proportion of minimal change between the two groups was then compared. Third, five blinded endoscopists with different levels of endoscopic experience assessed whether MCE was present. Intraobserver reproducibility and interobserver agreement were described using the kappa value. Results The proportion of MCE in the NERD group (70.8 %, 35/48) was higher than that in the control group (22.5 %, 9/40, P < 0.001) when diagnosed by the three experienced endoscopists. Detection rates for MCE using WLE combined with LCI were higher than those using WLE (43/88, 48.9 % vs. 29/88, 33.0 %, P < 0.001). With WLE combined with LCI, intraobserver reproducibility significantly improved, indicating that the combined approach can improve interobserver agreement compared with using WLE alone. Conclusions Endoscopic diagnosis of MCE using WLE combined with LCI images is effective. Intraobserver reproducibility and interobserver agreement in MCE can be improved when LCI is applied with conventional imaging (Clinical trial registration number: NCT03068572).

Conflict of interest statement

Competing interests None

Figures

Fig. 1
Fig. 1
Study flow diagram.
Fig. 2
Fig. 2
Endoscopic image of edema or accentuation of the mucosal folds. A Reddish mucosal change with circular erosion was noted at the squamocolumnar junction (arrow).aThe lesion is easily recognizable on link color imaging.bReddish mucosal change with edema was noted(arrow). The lesion is easily recognizable as a bright reddish area mixed with purple color on link color imaging.cA prominent gastric mucosal fold was noted at the squamocolumnar junction (arrow). The lesion is easily recognizable as red areas appear redder on link color imaging.

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