Diagnostic efficacy of magnifying endoscopy with blue laser imaging for laryngopharyngeal reflux

We aimed to analyze the utility of magnifying endoscopy with blue laser imaging (ME-BLI) in diagnosing laryngopharyngeal reflux (LPR).

The study enrolled 106 patients based on LPR-related symptoms. Using the reflux symptom index (RSI) and reflux finding score (RFS) scales as the clinical reference standard, the study cohort comprised 68 patients with LPR (RSI >13 and/or RFS >7) and 38 controls (RSI ≤13 and RFS ≤7). All participants underwent upper gastrointestinal endoscopy with ME-BLI. The patients were classified into Grades 1-4 based on the pharyngolaryngeal appearance under ME-BLI and the visibility and characteristics of intraepithelial papillary capillary loops (IPCLs) in the pharyngolaryngeal mucosa. Grades 3 and 4 were defined as LPR-positive. The diagnostic performance of ME-BLI for LPR was compared to the RSI/RFS criteria.

Compared with the RSI/RFS clinical reference standard, ME-BLI demonstrated a sensitivity of 89.71% (95% CI: 81.54-94.44%), a specificity of 73.68% (95% CI: 59.72-84.03%), a positive predictive value of 85.92% (95% CI: 76.34-92.04%), and a negative predictive value of 80.00% (95% CI: 64.06-90.04%) for LPR diagnosis. It also showed good consistency with RSI/RFS diagnosis (Kappa = 0.65, 95% CI: 0.52-0.78, p < 0.001). Good interobserver agreement in ME-BLI grading was noted (ICC = 0.858, p < 0.001).

LPR has characteristic pharyngeal manifestations. ME-BLI could potentially improve LPR diagnostic accuracy; however, further validation is required.