Equal detection rate of cervical heterotopic gastric mucosa in standard white light, high definition and narrow band imaging endoscopy

Abstract:

Background and aim: The prevalence of cervical heterotopic gastric mucosa (HGM) of the proximal oesophagus differs widely between studies, perhaps due to examination conditions during endoscopy. In this study we aimed to determine whether narrow band imaging (NBI) or high definition (HD) imaging improves detection of HGM. Possible factors of influence for HGM detection, in particular setting (position, timing, in-/out-patient), examination time and sedation parameters, were analysed.

Methods: Retrospective analysis of 641 consecutive patients who underwent an oesophagogastroduodenoscopy (EGD) by the same, substantially experienced endoscopist between June 2011 and August 2013. The type of endoscope was randomly assigned to patients.

Results: A total of 85 patients showed HGM with an overall prevalence of 13.3 %. The detection rate in the HD-NBI group was 18/127 (14.2 %) and in the HD white light (HDWL) group, 15/104 (14.4 %, p = 0.957). The detection rate between standard definition white light (SDWL) endoscopy (52/410, 12.7 %) and HD endoscopy did not differ significantly (33/231, 14.3 %, p = 0.566). Setting, sedation dosage and examination times were equally distributed between study groups. The indication of dysphagia (11.8 % vs. 2.4 % with p = 0.000, respectively) and dyspepsia (19.1 % vs. 10.8 %, p = 0.047, respectively) occurred significantly more often in HGM patients than in the control group. There was no difference in the detection rate depending on HGM size.

Conclusions: The prevalence of HGM in the upper EGD is high and does not differ significantly between the study groups of SDWL, HDWL and HD-NBI under equivalent conditions.

Zusammenfassung

Hintergrund: Die Prävalenz zervikaler heterotoper gastraler Muskosa (HGM) im proximalen Ösophagus zeigt in Abhängigkeit verschiedener Studien große Diskrepanzen. Möglicherweise liegen unterschiedliche Untersuchungsbedingungen während der Endoskopie zugrunde. Das Ziel der Studie ist der Vergleich unterschiedlicher Endoskopiemodalitäten [Standardweißlicht-Endoskopie (SDWL) vs. hochauflösende Endoskopie (HD) vs. Narrow Band Imaging (HD-NBI)].

Methodik: Retrospektive Analyse von 641 konsekutiven Patienten, die eine Gastroskopie in SDWL, HDWL oder HD-NBI durch einen erfahrenden Untersucher zwischen Juni 2011 und August 2013, erhalten haben.

Ergebnisse: 85 Patienten wurden mit HGM diagnostiziert, folglich liegt eine Detektionsrate von 13,3 % vor. Die Häufigkeit lag in der HD-NBI-Gruppe bei 18/127 (14,2 %) und in der HDWL-Gruppe bei 15/104 (14,4 % p = 0,957). Die Rate unterschied sich zwischen SDWL (52/410, 12,7 %) und HDWL nicht (33/231, 14,3 %, p = 0,566). Untersuchungssetting (Position, Zeitpunkt der Untersuchung, ambulante/stationäre Durchführung), Sedierungsdosierung und Untersuchungszeit waren unter den Studiengruppen gleich verteilt. HGM-Patienten zeigten jedoch häufiger Dysphagie (11,8 % vs. 2,4 %, p = 0,000) und Dyspepsie (19,1 % vs. 10,8 %, p = 0,047) als die Kontrollgruppe. In 61,4 % (n = 51) lag HGM als einzelner, in 28,9 % (n = 24) als doppelter und in 9,6 % (n = 8) als vielfacher Schleimhautbezirk vor. Es gab keine Unterschiede in der Detektionsrate aufgrund der Größe der HGM.

Diskussion: Die Detektionsrate von HGM im proximalen Ösophagus ist hoch und unterscheidet sich zwischen den Studiengruppen SDWL, HDWL und HD-NBI unter gleichen Untersuchungsbedingungen nicht.

Schlüsselwörter

Zervikale heterotope gastrale Muskosa - Narrow band imaging - Advanced imaging - Untersuchungsmodalitäten - Endoskopie

Key words

cervical heterotopic gastric mucosal patches - narrow band imaging - advanced imaging - examination setting - endoscopy

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