放大结合窄带成像在上消化道内镜检查中指导靶向活检的价值

目的探讨放大内镜（magnifying endoscopy，ME）结合窄带成像（narrow—band imaging，NBI）在上消化道胃镜检查中指导靶向活检的价值。方法筛选普通白光胃镜检查活检提示存在低级别上皮内瘤变的患者或直径大于2．0cm的胃溃疡患者，共200例，随机分成2组，2—4周复查胃镜。普通白光胃镜组：普通白光胃镜观察后局部活检。ME—NBI组：根据放大胃镜下表现，在病变最严重部位靶向活检。分析普通胃镜活检结果与ME—NBI靶向活检结果与最终病理诊断结果的关系。结果200例患者中，3例患者失访，共完成197例。普通白光胃镜组100例，其中食管病变23例，胃病变77例。ME—NBI组97例，其中食管病变19例，胃病变78例。ME-NBI组平均每例活检数（2．95块）与普通胃镜组（4．56块）相比差异具有统计学意义（P〈0．001）。与最终病理结果符合率：ME—NBI90．7％（88／97），普通胃镜71．0％（71／100）。两组间差异具有统计学意义（P〈0．01）。结论ME—NBI技术操作简便，可清晰观察病灶微细结构，有助于提高早期上消化道肿瘤的靶向活检准确率，在常规胃镜检查中发现可疑病灶后，可使用ME．NBI观察，指导靶向活检。

The value of magnifying endoscopy combined with narrow-band imaging for targeting biopsy of lesions in upper gastrointestinal tract

Objective To evaluate the value of magnifying endoscopy combined with narrow-band imaging for targeting biopsy of lesions in upper gastrointestinal tract. Methods A total of 200 patients who either had a lesion of low grade intra-epithelial neoplasia or a gastric ulcer larger than 2era in diameter in the referral endoscopy were randomly allocated to 2 groups to receive a second-look endoscopy with conventional white-light imaging （C-WLI） or magnifying endoscopy combined with narrow-band imaging （ME-NBI） 2-4 weeks later. In C-WLI group, esophagogastroduodenoscopy （EGD） was performed and conventional biopsy was carried out in the suspicious lesion. In ME-NBI group, diagnosis based on mucosal surface pattern and microvaseular patterns was conducted using ME-NBI and targeted biopsy was performed. The diagnostic ac- curacy of C-WLI and ME-NBI was compared with pathology. Results A total of 197 patients completed the study, with 100 patients in C-WLI group （77 gastric lesion and 23 esophageal lesion） and 97 in ME-NBI group （78 gastric lesion and 19 esophageal lesion）. The mean number of biopsies in C-WLI was larger than that in ME-NBI （4. 65 vs. 2. 95, P 〈0. 001 ）. The diagnostic accuracy of ME-NBI was greater than that of C-WLI （90. 7% vs. 71.0%, P 〈0. 01 ）. Conclusion Magnifying endoscopy with NBI has been shown to be more effective for targeting biopsy of lesions in the upper gastrointestinal tract. Detail detection using mag-nifying endoscopy combined with narrow-band imaging is highly recommended when suspicious lesions were found during conventional EGD practice.