Sandy B. Hall

Clinical utility and interobserver agreement of autofluorescence imaging and magnification narrow-band imaging for the evaluation of Barrett's esophagus: a prospective tandem study

BACKGROUND New endoscopic imaging techniques, such as autofluorescence imaging (AFI) and narrow-band imaging (NBI), have been developed to improve the detection of neoplastic lesions in Barretts esophagus (BE). OBJECTIVE To evaluate the clinical utility of AFI and magnification NBI to detect high-grade dysplasia (HGD) and early esophageal adenocarcinoma (EAC) and the interobserver agreement. DESIGN Prospective tandem study of eligible patients. SETTING Single, academic tertiary care center. PATIENTS Forty-two patients with a history of confirmed BE were prospectively enrolled. INTERVENTIONS The BE segment was examined under high-definition white-light endoscopy, and the presence of visible lesions was recorded. Subsequently, AFI and magnification NBI were performed in tandem on areas of the BE segment away from visible lesions; images obtained by these 2 systems were graded according to the color of reflected light and surface patterns, respectively. Biopsy specimens were obtained at the end of the procedure. MAIN OUTCOME MEASUREMENTS The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of the AFI and NBI patterns for the detection of HGD/EAC and interobserver agreement. RESULTS Of the 42 patients enrolled, 14 (33%) had HGD/EAC. On patient-based analysis, AFI alone had a sensitivity, specificity, and NPV of 50%, 61%, and 71%, respectively, and the overall accuracy for the detection of HGD/EAC patients was 57%. By using magnification NBI in tandem fashion, the sensitivity and NPV improved to 71% and 76%, respectively, with a decrease in specificity to 46% and in overall accuracy to 55%. The 2 techniques had moderate interobserver agreement for both the patterns and prediction of histology. LIMITATIONS Uncontrolled study performed at an academic center by expert endoscopists in a high-risk population. CONCLUSIONS By using a multimodality endoscope, both AFI and magnification NBI had limited clinical accuracy and moderate overall interobserver agreement. AFI does not appear to be useful as a broad-based technique for the detection of neoplasia in patients with BE.

Dilated intercellular spaces and lymphocytes on biopsy relate to symptoms in erosive GERD but not NERD

Aliment Pharmacol Ther 2011; 33: 1202–1208

Impact of Measurement of Esophageal Acid Exposure Close to the Gastroesophageal Junction on Diagnostic Accuracy and Event–Symptom Correlation: A Prospective Study Using Wireless Dual pH Monitoring

OBJECTIVES:Ambulatory esophageal pH monitoring has limited diagnostic accuracy in patients with gastroesophageal reflux disease (GERD), especially in those with non-erosive reflux disease (NERD). In addition, there is lack of symptom–reflux association in the majority of GERD patients. The aim of this study was to evaluate the impact of measuring acid exposure 1 cm above the gastroesophageal junction (GEJ) on diagnostic accuracy and symptom correlation in GERD patients compared with conventional pH measurements (6 cm above the GEJ) using the wireless pH system.METHODS:GERD patients and controls as defined by two validated questionnaires (Gastroesophageal Reflux Questionnaire and Reflux Disease Questionnaire) were prospectively enrolled. Under direct endoscopic vision, two wireless pH capsules (BRAVO, Given Imaging, Yokneam, Israel) were placed 6 and 1 cm, respectively, above the GEJ. Receiver operator characteristic curves were constructed, and symptom indexes were calculated separately for pH measurements at 6-cm (proximal) and 1-cm (distal) locations.RESULTS:A total of 40 GERD patients (20 erosive esophagitis (EE) and 20 NERD) and 16 controls were analyzed. Sensitivity and specificity of abnormal acid exposure times in GERD were as follows: proximal: 67 and 66%, distal: 60 and 88%; in EE proximal: 75 and 81%, distal: 84 and 92%; and in NERD proximal: 61 and 67%, distal: 58 and 66%, respectively. The proportion of patients with a positive symptom–reflux correlation in GERD was as follows: symptom index (SI): proximal: 35%, distal: 50%; symptom sensitivity index (SSI): proximal: 25%, distal: 5%; and symptom-associated probability (SAP): proximal: 30% and distal: 35%. The higher proportion of patients with a positive SI distally was due to the EE group (EE, proximal: 35% and distal: 65%; NERD, proximal: 35% and distal: 35%).CONCLUSIONS:Compared with the traditional location, measurement of acid reflux 1 cm above the GEJ improved the diagnostic accuracy as well as symptom correlation in EE, but not in NERD patients. Thus, pH monitoring 1 cm above the GEJ for improving the diagnosis of NERD cannot be recommended in clinical practice at this time.

The impact of pre‐endoscopy proton pump inhibitor use on the classification of non‐erosive reflux disease and erosive oesophagitis

Aliment Pharmacol Ther 2010; 32: 1266–1274

T1955 Presence of Hiatal Hernia (HH)Is Not Related to Obesity and Increasing Age

calculated from cross-sectional CT images. Results: The prevalence for MS was 27% in the cases and 19% in the controls (p <0.001). Multivariate logistic regression analysis demonstrated that MS is associated with RE (OR = 1.42, 95% CI: 1.26-1.60, p <0.001). Among the individual components of MS, WC (OR = 1.47, 95% CI: 1.30-1.65, p <0.001) and elevated triglyceride (OR = 1.20, 95% CI: 1.05-1.36, p = 0.006) independently increased the risk for RE. Cases showed higher mean VAT (136.1 ± 57.8 vs. 124.0 ± 54.7, p <0.001) and SAT (145.9 ± 56.8 vs. 133.5 ± 50.7, p <0.001). However, only VAT was an independent risk factor for RE after adjusting for multiple confounders (OR for the highest quartile of VAT =1 .61, 95% CI: 1.10-2.36, p=0 . 014). Conclusions: MS was associated with RE. Abdominal obesity, especially visceral obesity was an important risk factor for RE. Associations of Abdominal Fat Area, Measured By Abdominal CT Scan, with Reflux Esophagitis after Age-, Sex-, and WC-matching