美蓝染色对提高胃黏膜不典型病变活检阳性率的价值

目的探讨内镜下美蓝染色对胃黏膜不典型病变中早期胃癌及其癌前病变的诊断价值。方法将326例胃黏膜表现不典型的成人患者随机分成染色内镜组和普通内镜组，分别在病变部位活检送病理组织学检查。结果染色内镜组166例患者中，印例胃黏膜上皮有肠化、50例上皮呈轻度-中度不典型增生、8例为重度不典型增生、8例为早期胃癌且经手术及术后病理证实病灶仅限于黏膜层且无淋巴结转移。普通内镜组160例，病理检查结果为伴有肠上皮化生40例、轻-中度不典型增生20例、重度不典型增生2例，无早期胃癌。染色内镜组早癌及癌前病变总检出率为75．9％，其中早期胃癌检出率为12．1％，均明显高于普通内镜组。结论内镜下美蓝染色指导活检可提高胃黏膜不典型增生和早期胃癌的检出率。     

美蓝染色在胃癌前病变和早期胃癌中的应用

目的研究内镜下美蓝染色对胃癌前病变和早期胃癌的诊断价值。方法内镜下有胃黏膜异常表现的57例，用0．5％的美蓝均匀喷洒于胃黏膜，然后在染色的部位取活检送病理组织学检查。结果有36例存在肠化和不典型增生，4例为早期胃癌，均经手术及病理证实病灶仅限于黏膜层，且无淋巴结转移。结论内镜下美蓝染色可明显的提高胃癌前病变和早期胃癌的检出率。     

色素内镜对早期胃癌及癌前病变的诊断价值

研究内镜下美蓝染色对早期胃癌及癌前病变的诊断价值。内镜下有黏膜异常表现的120例患者，54例予以美蓝染色后活检，66例单纯活检。美蓝染色组病检证实有肠化萎缩者占23例，不典型增生15例，早期胃癌4例（均经手术病理证实）；单纯活检组（对照组）病理证实有肠化萎缩者占18例，不典型增生10例，未检出早期胃癌。染色组早期胃癌及癌前病变检出率为77．78％，对照组为40．90％，两组差别有显著性差异（P〈0．05）。结果表明，应用色素内镜指导黏膜活检，可显著提高早期胃癌和癌前病变的检出率。     

内镜下美蓝染色对早期胃癌及癌前病变的诊断价值

[目的]探讨内镜下直接喷洒低浓度美蓝染色对早期胃癌及癌前病变的诊断价值.[方法]对常规内镜检查发现胃黏膜有以下至少1项异常者:①微隆起,②糜烂,③小溃疡,④粗糙不平,⑤色泽改变,将其随机分为2组,各58例,染色组内镜下直接喷洒0.2%美蓝染色后活检;对照组不作染色按肉眼判断常规活检.[结果]染色组中检出早期胃癌3例、不典型增生15例、肠上皮化生17例;对照组中分别检出0、6、0例.2组检出率差异有统计学意义(P＜0.01).[结论]内镜下直接喷洒低浓度美篮染色可显著提高早期胃癌和癌前病变的检出率.     

内镜下醋酸联合靛胭脂染色对胃黏膜病变的诊断价值

目的 探讨内镜下醋酸联合靛胭脂染色对胃黏膜病变的诊断价值.方法 选择常规内镜下发现胃黏膜异常的门诊患者272例,随机分为对照组和醋酸联合靛胭脂染色组,每组各136例.对照组患者采取肉眼判断病灶并内镜下活检,染色组采取染色后活检,对比两组一般情况、镜下表现、活检病理、安全性等.结果 对照组检出早期胃癌4例(2.9％)、重度不典型增生3例(2.2％)、轻中度不典型增生11例(8.1％)、肠上皮化生35例(25.7％)、胃炎83例(61.0％),染色组分别为13例(9.6％)、12例(8.8％)、22例(16.2％)、54例(39.7％)及35例(25.7％).染色组对早期胃癌、重度不典型增生、肠上皮化生、胃炎的检出率高于对照组(P＜0.05).结论 醋酸联合靛胭脂染色可提高普通胃镜下黏膜异常的早期胃癌及癌前病变等的检出率.     

内镜下碘染色诊断早期食管癌的临床研究

目的 探讨内镜下碘染色对早期食管癌及癌前病变的诊断价值.方法 将内镜下有可疑食管病变的220例患者随机分为染色组和对照组各110例.用Lugol液对染色组进行食管黏膜染色检查,并对不染色和浅染色区进行病理活检.对照组不行Lugol液染色,仅根据临床经验进行病理活检.结果 染色组不着色或浅着色69例(62.7%),活检发现食管癌14例(12.7%),其中早期食管癌3例,鳞状上皮异型增生9例(8.1%);对照组110例活检发现食管癌2例(1.8%),轻中度异型增生4例(3.6%).两组食管癌诊断率的差异有统计学意义.结论 内镜下碘染色能减少食管黏膜活检误差,提高食管癌诊断率,有助于发现早期食管癌及其癌前病变.     

早期胃癌及癌前病变内镜下美蓝染色图像和组织学的关系

目的探讨早期胃癌及癌前病变的内镜下美蓝染色图像类型和组织学诊断的关系。方法对我院接受胃镜检查发现胃黏膜局限性充血、肿胀、糜烂、小溃疡、粗糙或微隆起病灶至少一项者,采用直接喷洒0·2%美蓝染料染色。染色图象分为4类:Ⅰ类:黑色或深蓝色,不易退色,周边黏膜浸润性改变明显;Ⅱ类:浅蓝色,介于深淡之间,周边黏膜无明显浸润性改变;Ⅲ类:淡蓝色,多发性弥漫状;Ⅳ类:隐约着色或不染。检查后按上述标准记录分类。病灶黏膜活检送病理学诊断。将染色后图象类别同组织病理学诊断进行对照,统计学分析。结果胃癌和异型增生分布在Ⅰ、Ⅱ类图像中者占82.92%,符合美蓝染色形成不同图象的原理和规律。结论美蓝染色形成的不同图象类别与组织病理学诊断密切相关,癌变程度所分泌的坏死物的多少是形成各类图象的原因。美蓝染色有助于早期胃癌的筛选、早期诊断和早期治疗,且易于推广应用。     

色素内镜对上消化道早期癌及癌前病变的诊断价值(附98例病例分析)

目的 探讨色素内镜对上消化道早期癌及癌前病变的诊断价值。方法 内镜下对98例可疑病变进行黏膜染色，分别在染色前后进行内镜诊断比较，并与活检或手术切除灶的病理结果分析对比。结果 食管黏膜染色36例，不着色区取材6例，病理报告鳞癌5例，腺癌1例，浅着色区取材30例，病理报告食管炎症12例，轻度不典型增生7例．中度不典型增生6例，重度不典型增生3例，鳞癌2例，浅着色区不典型增生诊断率为53．3％，染色前后食管癌诊断符合率分别为50％和75％，比较病理诊断，染色后诊断符合率提高25％。胃黏膜染色62例，病理诊断胃溃疡26例，伴异型增生10例，胃黏膜内癌18例，胃黏膜下癌15例，染色前后早期癌诊断分别为75．8％和87．9％，比较病理诊断，染色后诊断符合率提高12．1％。结论 色素内镜可提高病变活检准确率及上消化道早期癌及癌前病变的诊断率，方法简便安全，值得基层医院推广。     

内镜下碘染色对诊断食管癌及癌前病变的价值

[目的]探讨内镜下碘染色在诊断食管癌及癌前病变中的价值.[方法]在我市食管癌高发地区对239例40～69岁人群进行内镜下食管碘染色,观察食管黏膜染色情况,并取碘染异常区或贲门脊根部活检送病理组织学检查.[结果]239例接受内镜检查者其中有92例碘染色后出现不着色区或淡染区,病检示食管癌5例,检出率为2.09％,不典型增生病变46例（其中轻度不典型增生17,中重度不典型增生29例）,检出率为19.25％,慢性炎症33例,正常鳞状上皮8例.[结论]内镜下食管碘染色结合黏膜活检有助于早期食管癌及癌前病变的诊断,且操作简便,具有推广价值.     

胃黏膜上皮内瘤变组织中COX-2表达及其临床意义

目的探讨胃黏膜上皮内瘤变组织中环氧合酶(COX)-2蛋白的表达情况及其临床意义。方法采用免疫组织化学技术,检测56例内镜活检病理证实为上皮内瘤变的标本中COX-2蛋白的表达情况。结果(1)经HE染色识别的胃黏膜组织上皮内瘤变56例中轻度不典型增生18例,中度不典型增生18例,重度不典型增生17例,原位癌3例。(2)COX-2蛋白表达在轻度不典型增生、中度不典型增生、重度不典型增生和原位癌的阳性率分别为33.33%(6/18)、50%(9/18)、70.59%(12/17)和100%(3/3),各组间比较差异显著(P0.05)。高级别上皮内瘤变的阳性表达率(75%)明显高于低级别上皮内瘤变者(41.67%),两者比较差异显著(P0.01)。结论检测胃黏膜上皮内瘤变组织中COX-2蛋白表达可以帮助临床识别胃黏膜上皮内瘤变组织,预测胃癌前病变的进展,为临床选择治疗方案(ESD、外科手术等)提供依据。     

Endoscopic therapy of early gastric cancer

Endoscopic therapy of early gastric cancer is applicable for differentiated-type mucosal carcinomas that have an extremely low potency of lymph-node metastasis. Among various kinds of endoscopic therapy, endoscopic mucosal resection is the most recommended procedure, because pathological evaluation of affected tissues is available using this method. Recently, endoscopic submucosal dissection, a novel method of endoscopic mucosal resection, has gained interest as a more reliable therapeutic procedure. In the present chapter several issues will be presented on endoscopic therapy for early gastric cancer, including endoscopic diagnosis of early gastric cancer, currently accepted indications of endoscopic therapy, and the possibility of extending the indication and techniques used for mucosal resection.     

Endoscopic advances in the management of gastric cancer and premalignant gastric conditions

Gastric cancer is the fifth most common cancer and in 2018, it was the third most common cause of cancer-related deaths worldwide. Endoscopic advances continue to be made for the diagnosis and management of both early gastric cancer and premalignant gastric conditions. In this review, we discuss the epidemiology and risk factors of gastric cancer and emphasize the differences in early vs late-stage gastric cancer outcomes. We then discuss endoscopic advances in the diagnosis of early gastric cancer and premalignant gastric lesions. This includes the implementation of different imaging modalities such as narrow-band imaging, chromoendoscopy, confocal laser endomicroscopy, and other experimental techniques. We also discuss the use of endoscopic ultrasound in the diagnosis and staging of early gastric cancer. We then discuss the endoscopic advances made in the treatment of these conditions, including endoscopic mucosal resection, endoscopic submucosal dissection, and hybrid techniques such as laparoscopic endoscopic cooperative surgery. Finally, we comment on the current suggested recommendations for surveillance of both gastric cancer and its premalignant conditions.     

Unveiling lymph node metastasis in early gastric cancer

With respect to gastric cancer treatment,improvements in endoscopic techniques and novel therapeutic modalities[such as endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)]have been developed.Currently,EMR/ESD procedures are widely accepted treatment modalities for early gastric cancer(EGC).These procedures are most widely accepted in Asia,including in Korea and Japan.In the present era of endoscopic resection,accurate prediction of lymph node(LN)metastasis is a critical component of selecting suitable patients for EMR/ESD.Generally,indications for EMR/ESD are based on large Japanese datasets,which indicate that there is almost no risk of LN metastasis in the subgroup of EGC cases.However,there is some controversy among investigators regarding the validity of these criteria.Further,there are currently no accurate methods to predict LN metastasis in gastric cancer(for example,radiologic methods or methods based on molecular biomarkers).We recommend the use of a 2-step method for the management of early gastric cancer using endoscopic resection.The first step is the selection of suitable patients for endoscopic resection,based on endoscopic and histopathologic findings.After endoscopic resection,additional surgical intervention could be determined on the basis of a comprehensive review of the endoscopic mucosal resection/endoscopic submucosal dissection specimen,including lymphovascular tumor emboli,tumor size,histologic type,and depth of invasion.However,evaluation of clinical application data is essential for validating this recommendation.Moreover,gastroenterologists,surgeons,and pathologists should closely collaborate and communicate during these decisionmaking processes.     

Clinical outcomes of endoscopic submucosal dissection (ESD) for treating early gastric cancer: Comparison with endoscopic mucosal resection after circumferential precutting (EMR-P)

BackgroundTo achieve en bloc resection for large lesions, endoscopic mucosal resection after circumferential precutting and endoscopic submucosal dissection techniques have been developed.AimTo compare endoscopic submucosal dissection with endoscopic mucosal resection after circumferential precutting in terms of the clinical efficacy and safety.Patients and methods346 consecutive patients underwent their first endoscopic mucosal resection after circumferential precutting (103 patients) or endoscopic submucosal dissection (243 patients) for early gastric cancer and their clinical outcomes were compared.ResultsFor early gastric cancer ≥20 mm endoscopic submucosal dissection group demonstrated significantly higher en bloc resection and en bloc plus R0 resection rate compared with endoscopic mucosal resection after circumferential precutting group. For early gastric cancer with size of 10–19 mm, endoscopic submucosal dissection group also showed significantly higher en bloc resection rate. For early gastric cancer <20 mm, however, en bloc plus R0 resection rate for endoscopic mucosal resection after circumferential precutting group was comparable to that for endoscopic submucosal dissection group. In case of R0 resection of intramucosal differentiated cancer, neither group showed local recurrence during the median 29 and 17 months of follow-up. Two groups did not show significant difference in the bleeding or perforation rates.ConclusionFor early gastric cancer <20 mm endoscopic mucosal resection after circumferential precutting may be considered as an alternative choice to endoscopic submucosal dissection. However, for early gastric cancer ≥20 mm endoscopic submucosal dissection should be considered as the first choice for treating early gastric cancer.     

智能染色内镜对早期胃癌的诊断价值探讨

目的探讨富士能智能染色内镜（FICE）在早期胃癌中的诊断价值。方法2010年2月至2011年3月经普通胃镜检查后疑似早期胃癌的患者67例,分别行电子放大内镜、FICE染色放大内镜、靛胭脂染色放大内镜检查。对疑似病灶的胃黏膜腺管及微血管形态的清晰程度进行评分比较,并对疑似部位进行靶向活检,比较3种内镜诊断早期胃癌的敏感度、特异度以及与病理组织学的符合率。结果67例患者中,经病理组织学检查诊断为早期胃癌17例。FICE染色放大内镜与电子放大内镜、靛胭脂染色放大内镜在观察腺管结构显示方面差异无统计学意义（P〉0．05）。在观察微血管形态方面,FICE染色放大内镜明显好于电子放大内镜、靛胭脂染色放大内镜（P〈0．05）。在诊断早期胃癌的敏感度、特异度以及与病理组织学的符合率方面,FICE染色放大内镜分别为94．1％（16／17）、98．0％（49／50）、97．0％（65／67）,靛胭脂染色放大内镜分别为88．2％（15／17）、96．0％（48／50）、94．0％（63／67）,电子放大内镜分别为58．8％（10／17）、84．0％（42／50）、77．6％（52／67）,FIEC染色放大内镜均明显高于电子放大内镜（P〈0．05）,且均与靛胭脂染色放大内镜相近（P〉0．05）。结论FICE染色放大内镜可以更方便地提供清晰的血管图像,有助于早期胃癌的诊断,提高活检检查的准确率。     

Effects of omeprazole and famotidine on fibroblast growth factor-2 during artificial gastric ulcer healing in humans

BACKGROUND AND AIMS: Endoscopic mucosal resection is a widely accepted technique for the treatment of early gastric cancers, while large ulcers induced by the treatment should be treated promptly. This study aimed to compare the effects of omeprazole and famotidine on ulcer healing and fibroblast growth factor-2 levels in gastric ulcers induced by endoscopic mucosal resection. METHODS: Sixteen patients indicated for endoscopic mucosal resection were enrolled. They were treated by using either omeprazole (n = 8) or famotidine (n = 8) after endoscopic mucosal resection. Endoscopy was performed on days 4, 7 and 28 during each treatment period. Levels of fibroblast growth factor-2 in biopsy specimens were measured by using an enzyme-linked immunosorbent assay at the time of and after endoscopic mucosal resection. Histological variables were also assessed. RESULTS: Ulcer healing rates under endoscopy were not different between the two treatment groups. In both groups, levels of fibroblast growth factor-2 slightly increased on day 4, but the values were not different at any time point. There were no differences in histological variables on days 4 and 7, but fibromuscular hyperplasia was significantly greater in the omeprazole group than in the famotidine group on day 28 (P < 0.05). CONCLUSIONS: Omeprazole and famotidine have an equivalent value for the treatment of ulcers induced by endoscopic mucosal resection. While omeprazole had a more potent effect on fibromuscular hyperplasia than did famotidine, such a difference does not seem to be explained by fibroblast growth factor-2.     

Predictors of bleeding after endoscopic mucosal resection of gastric tumors

BACKGROUND: Endoscopic mucosal resection has been increasingly used to treat gastric tumors. Bleeding is the major complication of endoscopic mucosal resection. This study evaluated risk factors for bleeding associated with endoscopic mucosal resection. METHODS: Four hundred seventy-seven patients who underwent endoscopic mucosal resection of gastric tumors during the past 10 years were studied retrospectively. Bleeding encountered during endoscopic mucosal resection was termed immediate; bleeding after endoscopic mucosal resection was termed delayed. Univariate and multivariate analyses were used for determination of the factors related to delayed bleeding. One case of perforation was excluded. RESULTS: Delayed bleeding occurred in 25 (5.3%) of 476 patients. The only factor found to be significantly different between cases with and without delayed bleeding was the occurrence of immediate bleeding during endoscopic mucosal resection (p < 0.001). Sites where immediate bleeding occurred were not the same as those where delayed bleeding arose. There were no significant differences in other factors. CONCLUSIONS: When immediate bleeding occurs during endoscopic mucosal resection, there is an increased risk of delayed bleeding.     

Endoscopic closure of mucosal defects with metallic clips after endoscopic mucosal resection in patients with intramural tumors of the stomach: A retrospective study

Background: Representative complications of endoscopic mucosal resection to treat intramural gastric tumors include bleeding and perforation. The purpose of the present study was to clarify whether endoscopic closure of mucosal defects using metallic clips decreases the incidence of delayed bleeding following endoscopic mucosal resection. Patients and Methods: The records of 187 intramural tumors of the stomach in the 181 patients that were treated by endoscopic mucosal resection between 1992 and 2001 were reviewed retrospectively. The patients were classi?ed into two groups. The ?rst group included patients who received endoscopic mucosal resection but were not treated by endoscopic mucosal closure. The second group included patients who were treated with endoscopic mucosal closure using metallic clips after endoscopic mucosal resection. The incidences of delayed bleeding following endoscopic mucosal resection in these two groups were evaluated. Results: Delayed bleeding following endoscopic mucosal resection was observed in 13 of 96 (13.5%) of the lesions of the ?rst group. Delayed bleeding was encountered in only two of 91 (2.2%) lesions of the second group. Conclusions: Endoscopic closure of mucosal defects with metallic clips after endoscopic mucosal resection in gastric lesions was useful in decreasing the incidence of delayed bleeding following endoscopic mucosal resection.     

Predictive factors of lymph node metastasis in patients with undifferentiated early gastric cancers

BACKGROUND: For intramucosal differentiated early gastric cancer that has little risk of lymph node metastasis, local treatment such as endoscopic mucosal resection has been generally accepted as an adequate treatment. We studied clinicopathological characteristics of undifferentiated early gastric cancer at our institution to identify the predictive factors for lymph node metastasis and qualify lesions that should be referred for gastrectomy and not endoscopic mucosal resection. METHODS: We retrospectively analyzed the clinicopathological features (patient age and gender, tumor size, location, macroscopic type and histological type, presence of ulceration, depth of tumor invasion, and lymphatic-vascular involvement) in 332 patients with undifferentiated early gastric cancer who underwent gastrectomy with regional lymph node dissection. RESULTS: Lymph node metastasis was observed in 45 patients (14%). Univariate analysis revealed that depth of tumor invasion (submucosa), tumor size (>30 mm), and lymphatic-vascular involvement (positive) were associated with lymph node metastasis. Only lymphatic-vascular involvement (positive) was found to have a significant association (odds ratio, 7.4; 95% confidence interval, 2.9-19.0) by multivariate analysis. CONCLUSIONS: Lymphatic-vascular involvement was the only independent predictive risk factor for lymph node metastasis. This pathologic factor was not useful for identifying patients at high risk of lymph node metastasis who should be offered gastrectomy rather than endoscopic mucosal resection.     

Lymphatic invasion in small differentiated-type mucosal gastric cancer

Endoscopic resection for early gastric cancer is indicated for patients who are at negligible risk of lymph node metastasis. A 71-year-old female underwent endoscopic resection for a 15-mm differentiated-type mucosal gastric tumor, as recommended in the Japanese treatment guidelines. A histological examination revealed lymphatic invasion. Therefore, we performed laparoscopy-assisted distal gastrectomy and D1+ lymph node dissection. A histological examination detected no.3 lymph node metastasis, but no residual cancer cells were observed at the site of the endoscopic resection. This case is rare as lymphatic invasion and lymph node metastasis are highly unusual in small differentiated-type mucosal gastric cancer. Having experienced this case, we consider that en-bloc endoscopic resection of such lesions is extremely important, as it allows precise histological examinations to be performed, which can determine the necessity of additional treatment.