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

Bond, Ashley, Burkitt, Michael D ORCID: 0000-0002-5055-6408, Cox, Trevor, Smart, Howard L, Probert, Chris ORCID: 0000-0003-4550-0239, Haslam, Neil and Sarkar, Sanchoy (2017) Dual-focus Magnification, High-Definition Endoscopy Improves Pathology Detection in Direct-to-Test Diagnostic Upper Gastrointestinal Endoscopy. JOURNAL OF GASTROINTESTINAL AND LIVER DISEASES, 26 (1). pp. 19-24.

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Abstract

<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.

Item Type:	Article
Uncontrolled Keywords:	upper gastrointestinal tract, mucosal pathology, dual-focus magnification, high definition endoscopy, diagnosis
Depositing User:	Symplectic Admin
Date Deposited:	25 May 2017 07:01
Last Modified:	19 Jan 2023 07:03
DOI:	10.15403/jgld.2014.1121.261.gen
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3007637