Autofluorescence imaging and chromoendoscopy in the diagnosis of esophageal changes in bariatric patients.

Food obesity is one of the most common pathologies of modern society, and its complications are the most common cause of death in developed countries. Apart from cardiological and metabolic complications, the significant complications include an increased risk of developing neoplastic diseases. Gastrointestinal neoplasms are among the most common obesity-related neoplasms, including esophageal cancer. There are, therefore, proven reasons for the performance of surgical and endoscopic procedures aimed at reducing body weight by limiting the stomach volume. Unfortunately, almost 90 percent of patients treated surgically and endoscopically for obesity suffer from heartburn and retrosternal discomfort after meals, and endoscopic examinations show signs of complications of long-term gastroesophageal reflux, including metaplasia of erosive esophagitis and Barrett metaplastic changes. Therefore, it is necessary to conduct screening tests of obese patients after endoscopic and surgical treatment due to the predisposition to the development of these precancerous transformations. Thanks to the use of digital techniques, modern endoscopy of the upper gastrointestinal tract allows for a significant increase in the sensitivity of endoscopic examination in search of metaplasia foci, both in the stomach and in the esophagus. These include techniques such as aufotfluorescence and virtual chromoendoscopy (NBI and FICE). The study included 232 patients up to five years after bariatric obesity treatment, including sleeve gastrectomy (43%) and a gastric balloon (57%). During the endoscopic examination, white light (WLE), NBI, FICE and autofluorescence assessments were performed to look for foci of metaplasia in the esophagus. Acetic acid solutions were then used to increase the contrast between the suspected metaplasia area and the healthy tissue, and then the sections were taken according to the Seattle protocol in metaplastic segments and under the control of AFI, NBI and FICE. The obtained results were analyzed statistically. As a result of the conducted research, statistically significantly more changes were observed within the z-line with the use of NBI, AFI and FICE compared to endoscopy in white light. After the use of acetic acid solution, the contrast of changes in the esophagus and the z-line was increased. The obtained images of the mucosal tissue were analyzed in real time, and on the basis of the NBI FICE and AFI images, biopsy sites were selected where a histopathological image of metaplasia with low and high grade of dysplasia was obtained. The sensitivity and specificity of detecting dysplasia in Barrett's esophagus segments in WLE, NBI, FICE, and AFI were 67%, 92%, 94% vs. 94%. Real-time image analysis, including the analysis of vascular tissue and autofluorescence, made it possible to detect dysplasia in WLE, NBI, FICE, AFI in 69%, 94%, 96% vs 99% in AFI, respectively. As a result of the conducted research, it was concluded that the study with the use of AFI allows for a significant increase in the sensitivity of biopsy in patients with esophageal lesions compared to the adopted biopsy protocol.