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Article 6, 1/2017

ORIGINAL PAPER

Dual-focus Magnification, High-Definition Endoscopy Improves Pathology Detection in Direct-to-Test Diagnostic Upper Gastrointestinal Endoscopy

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Ashley Bond1,2,*, Michael D. Burkitt1,2,*, Trevor Cox3, Howard L. Smart1, Chris Probert1,2, Neil Haslam1, Sanchoy Sarkar1

1) Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospital Trust;
2) Clinical Cancer Trials Unit, University of Liverpool;
3) Unit of Gastroenterology Research, Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.261.gen

ABSTRACT
Background: In the UK, the majority of diagnostic upper gastrointestinal (UGI) endoscopies are a result of direct-to-test referral from the primary care physician. The diagnostic yield of these tests is relatively low, and the burden high on endoscopy services. Dual-focus magnification, high-definition endoscopy is expected to improve detection and classification of UGI mucosal lesions and also help minimize biopsies by allowing better targeting.
Methods: This is a retrospective study of patients attending for direct-to-test UGI endoscopy from January 2015 to June 2015. The primary outcome of interest was the identification of significant pathology. Detection of significant pathology was modelled using logistic regression.
Results: 500 procedures were included. The mean age of patients was 61.5 (±15.6) years; 60.8% of patients were female. Ninety-four gastroscopies were performed using dual-focus magnification high-definition endoscopy. Increasing age, male gender, type of endoscope, and type of operator were all identified as significant factors influencing the odds of detecting significant mucosal pathology. Use of dual-focus magnification, high-definition endoscopy was associated with an odds ratio of 1.87 (95%CI 1.11-3.12) favouring the detection of significant pathology. Subsequent analysis suggested that the increased detection of pathology during dual-focus magnification, high-definition endoscopy also influenced patient follow-up and led to a 3.0 fold (p=0.04) increase in the proportion of patients entered into an UGI endoscopic surveillance program.
Conclusion: Dual-focus magnification, high-definition endoscopy improved the diagnostic yield for significant mucosal pathology in patients referred for direct-to-test endoscopy. If this finding is recapitulated elsewhere it will have substantial impact on the provision of UGI endoscopic services.
Key words: upper gastrointestinal tract – mucosal pathology – dual-focus magnification – high definition endoscopy – diagnosis.
Abbreviations: 2WR: 2 week rule; AFI: Autofluorescence imaging; ASGE: American Society for Gastrointestinal Endoscopy; JAG: Joint Advisory Group; MDT: Multi-disciplinary team; NBI: Narrow band imaging; NICE: National Institute for Health and Care Excellence; OA: open access; UGI: Upper gastrointestinal.