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).
