Summary
Objective
To explore the use of real-time virtual chromoendoscopy (i-scan) in characterizing
the mucosal changes present in subjects with suspected laryngopharyngeal reflux (LPR)
and to compare the inter-rater and intra-rater agreement of Reflux Finding Scores
(RFS) from both laryngologists and general otolaryngologists (ORL) observing exams
using both white light endoscopy (WLE) and i-scan.
Methods
This is a cross-sectional study that included 66 subjects: 46 symptomatic and 20 asymptomatic
of suspected LPR based on the reflux symptom index (RSI). Subjects underwent flexible
video laryngoscopic evaluation of the larynx utilising both WLE and i-scan during
one continuous exam. Subjects also underwent 24-hour oropharyngeal pH-monitoring (Dx-pH).
Two laryngologists and two general otolaryngologists evaluated the anonymized videos
independently using RFS. Dx-pH results were interpreted using the pH graph, report
and RYAN score. Subjects were then designated into one of three groups: no reflux,
acid reflux and alkaline reflux.
Results
For the symptomatic group, no mucosal irregularities or early mucosal lesions were
observed except in one subject who had granulation tissue. The mean RFS using WLE
and i-scan were, respectively: 11.8 (SD 6.1) and 11.3 (SD 5.6) in symptomatic and
7.3 (SD 5.7) and 7.3 (SD 5.2) in asymptomatic group. The inter-rater agreement of
RFS using WLE and i-scan for both groups were good with intraclass correlation, ICC
of 0.84 and 0.88 (laryngologists); and 0.85 and 0.81 (ORL). The intra-rater agreement
among all four raters were good to excellent and similar for both WLE and i-scan (ICC
of 0.80 to 0.99). 47 of 66 subjects had evidence of LPR on Dx-pH results which more
specifically showed 39 subjects had “acid reflux” and 8 had “alkaline reflux”. Sixteen
subjects demonstrated a positive RYAN score but showed none were significantly correlated
with their RFS.
Conclusions
This study reports the first utilization of real-time video chromoendoscopy with i-scan
technology through high-definition flexible endoscopes to attempt to characterize
laryngopharyngeal findings in patients suspected of having LPR. Both general otolaryngologists
and laryngologists were equally capable of reliably calculating the RFS using both
WLE and i-scan, however no significant improvement in agreement or change in RFS was
found when i-scan technology was employed.
Level of evidence
Level 2
Key Words
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Article info
Publication history
Published online: July 24, 2022
Accepted:
June 8,
2022
Publication stage
In Press Corrected ProofFootnotes
This project received Fundamental Funding of Universiti Kebangsaan Malaysia Medical Center (UKMMC) under Project Code: FF-2019-213 and external funding by Pentax Medical Singapore Pte. Ltd.
Dr. Carroll is a consultant for Pentax Medical, Inc.
Identification
Copyright
© 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
