Endoscopy 2021; 53(07): 674-682
DOI: 10.1055/a-1224-6822
Original article

Narrow-band imaging versus Lugol chromoendoscopy for esophageal squamous cell cancer screening in normal endoscopic practice: randomized controlled trial

Mélissa Gruner
1  Gastroenterology Division, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
,
Angélique Denis
2  Pole de Santé Publique, Statistics and Medical Research Department, Hospices Civils de Lyon, Lyon, France
,
Claude Masliah
3  Gastroenterology Division, Clinique Mutualiste de l’Estuaire, Saint Nazaire, France
,
Morgane Amil
4  Gastroenterology Division, Centre Hospitalier Départemental Les Oudairies, La Roche sur Yon, France
,
Elodie Metivier-Cesbron
5  Gastroenterology Division, Centre Hospitalo-Universitaire Larrey, Angers, France
,
Dominique Luet
5  Gastroenterology Division, Centre Hospitalo-Universitaire Larrey, Angers, France
,
Medhi Kaasis
6  Gastroenterology Division, Centre Hospitalier de Cholet, Cholet, France
,
Emmanuel Coron
7  Hepatogastroenterology Department, Hotel Dieu, Nantes, France
,
Marc Le Rhun
7  Hepatogastroenterology Department, Hotel Dieu, Nantes, France
,
Stéphane Lecleire
8  Gastroenterology Division, Hôpital Charles Nicolle, Centre Hospitalo-Universitaire, Rouen, France
,
Michel Antonietti
8  Gastroenterology Division, Hôpital Charles Nicolle, Centre Hospitalo-Universitaire, Rouen, France
,
Jean-Louis Legoux
9  Gastroenterology Division, Hôpital La Source, Centre Hospitalier Régional, Orléans, France
,
Laurent Lefrou
9  Gastroenterology Division, Hôpital La Source, Centre Hospitalier Régional, Orléans, France
,
Pascal Renkes
10  Gastroenterology Division, Hôpital Clinique Claude Bernard, Metz, France
,
Anne-Laure Tarreirias
11  Gastroenterology Division, Hôpital Foch, Suresnes, France
,
Philippe Balian
11  Gastroenterology Division, Hôpital Foch, Suresnes, France
,
Philippe Rey
12  Gastroenterology Division, Hôpital d’Instruction des Armées, Legouest, Metz, France
,
Bénédicte Prost
13  Gastroenterology Division, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
,
Christophe Cellier
14  Gastroenterology Division, Hôpital Européen Georges Pompidou, Paris, France
,
Gabriel Rahmi
14  Gastroenterology Division, Hôpital Européen Georges Pompidou, Paris, France
,
Elia Samaha
14  Gastroenterology Division, Hôpital Européen Georges Pompidou, Paris, France
,
Serge Fratte
15  Gastroenterology Division, Centre Hospitalier Régional, Belfort, France
,
Béatrice Guerrier
16  Gastroenterology Division, Centre Hospitalier Bourg en Bresse, Bourg en Bresse, France
,
Verena Landel
17  Direction Recherche Clinique et Innovations, Hospices Civils de Lyon, Lyon, France
,
Sandrine Touzet
2  Pole de Santé Publique, Statistics and Medical Research Department, Hospices Civils de Lyon, Lyon, France
,
Thierry Ponchon
1  Gastroenterology Division, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
18  Lyon 1 University Claude Bernard, Lyon, France
19  INSERM U1032, LabTAU, Lyon, France
,
Mathieu Pioche
1  Gastroenterology Division, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
18  Lyon 1 University Claude Bernard, Lyon, France
19  INSERM U1032, LabTAU, Lyon, France
› Author Affiliations
Trial Registration: ClinicalTrials.gov Registration number (trial ID): NCT04224896 Type of study: randomized controlled study.

Abstract

Background Narrow-band imaging (NBI) is as sensitive as Lugol chromoendoscopy to detect esophageal squamous cell carcinoma (SCC) but its specificity, which appears higher than that of Lugol chromoendoscopy in expert centers, remains to be established in general practice. This study aimed to prove the superiority of NBI specificity over Lugol chromoendoscopy in the detection of esophageal SCC and high grade dysplasia (HGD) in current general practice (including tertiary care centers, local hospitals, and private clinics).

Methods This prospective randomized multicenter trial included consecutive patients with previous or current SCC of the upper aerodigestive tract who were scheduled for gastroscopy. Patients were randomly allocated to either the Lugol or NBI group. In the Lugol group, examination with white light and Lugol chromoendoscopy were successively performed. In the NBI group, NBI examination was performed after white-light endoscopy. We compared the diagnostic characteristics of NBI and Lugol chromoendoscopy in a per-patient analysis.

Results 334 patients with history of SCC were included and analyzed (intention-to-treat) from 15 French institutions between March 2011 and December 2015. In per-patient analysis, sensitivity, specificity, positive and negative likelihood values were 100 %, 66.0 %, 21.2 %, and 100 %, respectively, for Lugol chromoendoscopy vs. 100 %, 79.9 %, 37.5 %, and 100 %, respectively, for NBI. Specificity was greater with NBI than with Lugol (P = 0.002).

Conclusions As previously demonstrated in expert centers, NBI was more specific than Lugol in current gastroenterology practice for the detection of early SCC, but combined approaches with both NBI and Lugol could improve the detection of squamous neoplasia.

Supplementary material



Publication History

Received: 28 January 2020

Accepted: 22 July 2020

Publication Date:
22 July 2020 (online)

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