Endoscopy 2009; 41(2): 107-112
DOI: 10.1055/s-0028-1119469
Original article

© Georg Thieme Verlag KG Stuttgart · New York

High-definition endoscopy with i-Scan and Lugol’s solution for more precise detection of mucosal breaks in patients with reflux symptoms

A.  Hoffman1 , N.  Basting1 , M.  Goetz1 , A.  Tresch3 , J.  Mudter1 , S.  Biesterfeld2 , P.  R.  Galle1 , M.  F.  Neurath1 , R.  Kiesslich1
  • 1I Med Clinic, Johannes Gutenberg University Mainz, Germany
  • 2Institute of Pathology, Johannes Gutenberg University Mainz, Germany
  • 3Institute of Medical Statistics, Epidemiology and Informatics, Johannes Gutenberg University Mainz, Germany
Further Information

Publication History

submitted 11 July 2008

accepted after revision 20 November 2008

Publication Date:
12 February 2009 (online)

Background and study aims: Patients with gastroesophageal reflux disease are subdivided into non-erosive (NERD) and erosive reflux disease (ERD). The newly available EPKi processor enables high-definition resolution above HDTV standard (HD+). The aim of the study was to test the efficacy of HD+ esophagogastroduodenoscopy alone and in conjunction with i-Scan (newly developed postprocessing digital filter) and chromoendoscopy (Lugol’s solution) for differentiation of reflux patients.

Methods: The distal esophagus of patients with heartburn was inspected with three imaging modalities. HD+ was followed by i-Scan and 15-mL Lugol’s solution (1.5 %). The esophagus was evaluated for mucosal breaks (Los Angeles Classification [LA]). Small visible changes were also characterized, and targeted biopsies were performed. End points of the study were the presence and grade of esophagitis and the number of circumscribed changes.

Results: A total of 50 patients were included (female 29; mean age 54.7 years). HD+ identified nine patients with mucosal breaks (LA 7A; 2C), i-Scan was able to detect 12 patients (LA 8A; 2B; 2C; 0D) (P = n. s.) and chromoendoscopy identified 25 patients (LA 16A; 7B; 1C, 1D) (P < 0.01). Furthermore, a higher grade of esophagitis was recognized by using i-Scan and Lugol’s solution in 19 patients. The number of circumscribed lesions could be increased from 21 (HD+) to 58 (i-Scan) (P < 0.01), and up to 85 after Lugol spraying (P < 0.01).

Conclusions: Lugol’s solution in conjunction with HD+ endoscopy significantly improves the identification of patients with esophagitis and reduces misclassification. The i-Scan filter and chromoendoscopy help to identify reflux-associated lesions.

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A. HoffmanMD 

I. Med. Clinic
Johannes Gutenberg University of Mainz

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