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J Gastrointestin Liver Dis. 2017 Mar;26(1):19-24. doi: 10.15403/jgld.2014.1121.261.gen.

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

Author information

1
Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospital Trust;Clinical Cancer Trials Unit, University of Liverpool,Liverpool, UK.
2
Department of Cellular and Unit of Gastroenterology Research Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
3
Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, UK.
4
Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, UK. sanchoy@aol.com.

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.

PMID:
28338109
DOI:
10.15403/jgld.2014.1121.261.gen
[Indexed for MEDLINE]
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