Diagnostic Yield of Routine Chromoendoscopy for Esophageal Dysplasia in Asymptomatic Older Population

摘要

Background and Alms: Esophageal cancer is one of the neoplasm with the worst prognosis among digestive tract tumors, probably due to late detection. The aim of this study was to evaluate the diagnostic yield of routine chromoendoscopy using Lugol's solution for the detection of esophageal dysplasia in patients with old age (>65 years). Patients and Method: From March 2005 to October 2005, a prospective observational study involving 143 patients was carried out. All patients underwent conventional esophagoscopy during insertion of scope, and followed by chromoendoscopy using 2% Lugol's solution on the entire esophagus during scope withdrawal. The endoscopic appearances before and after staining were compared, and biopsies were obtained from all unstained areas after spraying Lugol's solution. A total of 143 patients were enrolled in the study and were divided into 2 groups according to endoscopic findings or biopsy results; no dysplasia vs. dysplasia group. Factors that can be related to the presence ofesophageal dysplasia in asymptomatic older patients were analyzed. Results: The study population was made up of 143 patients between the ages of 65 and 84 (mean 71.5 i 4.9 years; M: F = 82:61). Chromoendoscopy was well tolerated in all patients without significant adverse effects. Of these, a total of 67 unstained areas in 36 (25.2%) patients (17 patients; one unstained area, 19 patients; more than two unstained areas) were detected by chromoendoscoy in the esophagus and biopsy was performed at each unstained area. However, all of these unstained areas were not detected by conventional endoscopy. Of these 67 areas, 47 areas had diameters between 1 and 5 mm, 19 areas between 6 and 10 mm, and 1 area over 11 mm. About half (n = 34 areas; 50.7%) of unstained areas were located in the lower esophagus, and the rest of them were in the middle (n = 27; 40.3%) and.upper (n =6; 9%) esophagus. As a result of histology, 12 lesions in 7 patients and 2 lesiojis in 2 patients were diagnosed as low-grade dysplasia and high-grade dysplasia, respectively. However, there were no significant associations between esophageal dysplasia and gender, past history of smoking or alcohol, Barrett's esophagus, reflux esophagitis, location and diameter of lesion. Conclusions: In asymptomatic older population, routine chromoendoscopy significantly improves the detection rate of esophageal dysplasia, which can be overlooked by conventional endoscopy, and therefore, should be considered for routine clinical practice for this older population.