Chromoendoscopy and narrow-band imaging compared with high-resolution magnification endoscopy in Barrett's esophagus
Chromoendoscopy and narrow-band imaging compared with high-resolution magnification endoscopy in Barrett's esophagus
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DOI：
10.1053/j.gastro.2008.01.003
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发表时间：
2008-03-01
期刊：
影响因子：
29.4
通讯作者：
Bergman, Jacques
中科院分区：
文献类型：
--
作者：
Curvers, Wouter;Baak, Lubbertus;Bergman, Jacques
背景与目的：本研究的目的是比较高分辨率白光内镜、靛蓝胭脂色素内镜、醋酸色素内镜和窄带成像获得的放大静止图像，以确定用于Barrett食管的最佳技术。方法：采用上述4种技术对22个部位进行放大成像。7名没有Barretes食管或先进成像技术专业知识的内窥镜专家和5名该领域的国际专家对这22个区域的整体图像质量、粘膜图像质量和血管图像质量进行了评估。此外，评估粘膜和血管模式的规律性以及异常血管的存在，这与组织学有关。结果：所有观察者对白光图像粘膜形态学3个特征的一致性范围为kappa = 0.51（95%置信区间[CI]: 0.46-0.55）至kappa = 0.53 (95% CI: 0.50 - 0.57)，专家kappa = 0.43 （95% CI: 0.33-0.54）至kappa = 0.53 (95% CI: 0.41-0.64)，非专家kappa = 0.51 （95% CI: 0.15 - 0.33）至kappa = 0.64 （95% CI: 0.58 - 0.70）。在这些组中，观察者之间的一致性并没有通过添加一种增强技术而得到改善。所有观察者用白光图像识别早期肿瘤的成功率为86%，专家为90%，非专家为84%。增强技术的加入并没有改善肿瘤的产量。结论：靛蓝胭脂红内镜、醋酸内镜或窄带成像与白光图像的结合并不能提高观察者间的一致性，也不能提高Barrett食管早期肿瘤的鉴别率。
Background & Aims: The aim of this study was to compare magnified still images obtained with high-resolution white light endoscopy, indigo carmine chromoendoscopy, acetic acid chromoendoscopy, and narrow-band imaging to determine the best technique for use in Barrett's esophagus. Methods: We obtained magnified images from 22 areas with the 4 aforementioned techniques. Seven endoscopists with no specific expertise in Barretes esophagus or advanced imaging techniques and 5 international experts in this field evaluated these 22 areas for overall image quality, mucosal image quality, and vascular image quality. In addition, the regularity of mucosal and vascular patterns and the presence of abnormal blood vessels were evaluated, and this was correlated with histology. Results: The interobserver agreement for the 3 features of mucosal morphology with white light images ranged from kappa = 0.51 (95% confidence interval [CI]: 0.46-0.55) to kappa = 0.53 (95% CI: 0.50 - 0.57) for all observers, from kappa = 0.43 (95% CI: 0.33-0.54) to kappa = 0.53 (95% CI: 0.41-0.64) for experts, and from kappa = 0.51 (95% CI: 0.15 - 0.33) to kappa = 0.64 (95% CI: 0.58 - 0.70) for nonexperts. The interobserver agreement in these groups did not improve by adding one of the enhancement techniques. The yield for identifying early neoplasia with white light images was 86% for all observers, 90% for experts, and 84% for nonexperts. The addition of enhancement techniques did not improve the yield neoplasia. Conclusions: The addition of indigo carmine chromoendoscopy, acetic acid chromoendoscopy, or narrow-band imaging to white light images did not improve interobserver agreement or yield identifying early neoplasia in Barrett's esophagus.