色素胃镜对胃早癌及癌前病变的诊断价值

目的探究色素胃镜在胃早癌及癌前病变诊断中的应用价值。方法对武汉大学人民医院365例胃镜检查发现可疑胃黏膜病变者,用靛胭脂或美兰染液染色后取活检,结合病理分析,探讨内镜下病变部位颜色改变与活检病理结果的关系。结果365例患者中,靛胭脂染色组(n=168)病理诊断为癌、癌前病变及慢性炎等良性病变分别为27、53和88例,癌及癌前病变的整体检出率为47.6%,黏膜褪色、着色不良及染色正常检出率为100%、36.9%、5.4%,差异有统计学意义(χ~2=81.999,P0.01)。美兰染色组(n=197)检出癌、癌前病变及慢性炎分别为17、88、92例,癌及癌前病变的检出率为53.3%,深蓝色、淡蓝色及正常染色分别为98.1%、44.5%和3.8%,差异有统计学意义(χ~2=71.103,P0.01)。结论色素胃镜能鉴别胃黏膜病变,指导活检可提高胃早癌及癌前病变的检出率。     

超声内镜联合染色内镜在早期食管癌诊断中的应用价值

目的:分析超声内镜联合染色内镜技术诊断早期食管癌的准确性,评价其临床应用价值.方法:2009-08/2011-09行普通白光内镜(WLE)检查发现食管黏膜可疑病变67例,患者72处病灶纳入研究,可疑病变包括食管黏膜粗糙、糜烂、颜色异常、微隆起等.所有病变行活组织病理检查,分析超声内镜联合染色内镜诊断早期食管癌的准确性.结果:72处局灶性病变中,病理组织学证实癌性病变16处(9处病变行内镜下黏膜切除术或内镜黏膜下剥离术治疗,7处病变行手术治疗).非癌性病变56处,为慢性炎症、轻-中度不典型增生.WLE诊断早期食管癌的敏感度、特异度和准确性分别为:81.3%、66%、62.5%;超声内镜联合染色内镜对应值分别为:87.5%、98.2%、95.8%.结论:超声内镜联合染色内镜对食管病变有较高的诊断价值,尤其是对诊断早期食管癌及癌前病变有重要意义.     

430例上消化道早期癌及癌前病变ESD术前活检与术后病理差异性分析

目的比较上消化道不同部位黏膜病变内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)术前胃镜活检病理与术后病理的差异。方法回顾性分析我院2018年1月至2019年9月因食管、胃黏膜病变行ESD治疗的患者共430例,比较不同部位(食管、贲门、胃体、胃角、胃窦)及有无静脉麻醉的胃镜活检病理与ESD术后病理结果准确性的差异。结果 430例病灶中,食管206例,贲门93例,胃体40例,胃角40例,胃窦51例。胃镜术前活检病理与ESD术后病理诊断完全符合率为52.1%,ESD术后病理升级病灶为187例(43.5%),病理降级病灶为19例(4.4%)。各个部位符合率分别为58.3%、40.8%、52.5%、45.0%、52.9%,差异无统计学意义(P0.05)。将ESD术前活检病理分类为轻判与非轻判两个组,单因素Logistic回归分析结果表明:较大面积的病灶术前活检轻判率增加差异有统计学意义(P0.05),而对于病灶部位、形态、活检组织块数、有无静脉麻醉差异无统计学意义(P0.05)。430例病灶中,术前活检由我院完成的有160例,其中麻醉胃镜97例,普通胃镜63例,麻醉胃镜与普通胃镜术前活检病理与ESD术后活检病理轻判率分别为38.1%(37/97)vs 52.4%(33/63),差异无统计学意义(P0.05)。结论胃镜活检病理与ESD术后病理存在一定差异性,1/3以上的病灶有轻判的可能,故活检病理为癌前病变时应需进一步充分评估。上消化道各个部位的活检病理的准确性,差异无统计学意义。麻醉胃镜术前活检的轻判率低于普通胃镜,二者差异无统计学意义,但对于普通胃镜检查完成度不满意时,应建议麻醉胃镜下进一步评估。     

内镜黏膜下剥离术治疗SiewertⅡ型胃食管交界早期癌及癌前病变的临床分析

目的 探讨内镜黏膜下剥离术（endoscopic submucosal resection,ESD）治疗胃食管交界早期癌及癌前病变的安全性和有效性。方法 回顾性分析2012年7月—2019年6月间在北京大学第一医院内镜中心接受ESD治疗的67例SiewertⅡ型胃食管交界早期癌及癌前病变患者资料,对病变的临床病理特征、整块切除率、完全切除率、治愈性切除率、并发症发生率进行统计分析,并对可能影响治愈性切除的因素进行分析。结果 67例病变中隆起型病变5例,浅表型病变59例,凹陷型病变3例。病变中位直径1.6(1.8)cm,中位手术时间60.0(56.0)min。整块切除率97.0%（65/67）,完全切除率91.0%（61/67）,治愈性切除率82.1%（55/67）。肿瘤最大径（OR=8.457,95%CI：1.227~58.302,P=0.030）及病理类型（OR=15.133,95%CI：1.518~150.870,P=0.021）与非治愈性切除相关。3例（4.5%）患者发生ESD相关并发症,1例术后迟发出血,内镜下止血后好转;2例术后瘢痕狭窄,内镜引导下探条扩张后好转。58例随访患者中1例垂直切缘阳性且未接受后续治疗的患者出现复发;1例患者随访中发现异时性早期胃癌,再次ESD切除。结论 ESD治疗胃食管交界早期癌及癌前病变安全有效,操作前应对病变大小、边界、浸润深度进行准确评判,制定适宜的治疗方式及手术策略。     

胃镜形态学酷似良性隆起性病变的早期胃癌18例分析

胃镜诊断为良性隆起性病变的 6 93例中病理组织学诊断为早期胃癌 18例 ,占 2 .5 9%。早期胃癌并不具有特异性临床症状 ,对 40岁以上 ,有明显消化不良症状或癌前期病变患者 ,应常规作胃镜检查加活检 ;胃内隆起性病变形态学似良性者 ,仍需在病灶区域多处活检 ,才能提高胃癌的诊断率 ;强调掌握内镜活检取材要点和准确方法是诊断早期胃癌的关键 ;加强癌前病变的随访是发现早期胃癌的重要措施     

多环黏膜切除术(MBM)诊治食管早期癌和癌前病变

目的探讨胃镜下多环黏膜切除术(MBM)在诊治食管早期癌和癌前病变中的临床应用价值。方法回顾分析2011年1月至2014年2月胃镜下行MBM诊治的52例患者的临床资料。结果碘染色后病变黏膜呈淡染区或不着色区患者52例,单纯活检病理发现早期癌4例,MBM组织标本证实为癌者14例。单纯活检癌检出率7.69%,MBM组织癌检出率26.92%;单纯活检病理与MBM组织病理对照相符者42例,占80.76%,不相符者10例,占19.24%。未发生大出血或穿孔等严重并发症。内镜随访1~18个月未见肿瘤复发。结论 MBM操作相对简单、安全,在食管癌高发区早期癌和癌前病变的诊疗中值得推广。     

亚甲蓝染色对胃癌前病变的诊断价值

目的研究胃镜下亚甲蓝染色对胃癌前病变的诊断价值。方法胃镜下有胃黏膜异常表现的46例患者,用0.5%的亚甲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。将同期胃镜下有胃黏膜异常表现但未染色的50例作为对照组。结果染色组有29例存在胃黏膜肠上皮化生(gastric intestinal metaplas,GIM)和不典型增生(atypical hyperplasia,ATP),检出率63.04%,对照组检出率为24%。结论胃镜下亚甲蓝染色可明显提高胃癌前病变的检出率。     

超声胃镜小探头检查上消化道隆起性病变的临床价值

目的探讨超声胃镜小探头应用于检查上消化道隆起性病变的临床价值。方法选取2014年3月至2017年3月在宿迁市人民医院行超声胃镜小探头检查的100例上消化道隆起病变患者作为研究对象。患者入院后均使用超声胃镜小探头检查,评价超声胃镜小探头在上消化道隆起病变检查中的诊断价值。结果 100例患者经超声胃镜小探头检查,其中食管病变32例(32.0%),胃部病变63例(63.0%),贲门病变2例(2.0%),十二指肠病变3例(3.0%);诊断出间质瘤、平滑肌瘤和息肉病发率最高,其中间质瘤48例(48.00%),平滑肌瘤16例(16.00%),息肉12例(12.00%),其他还包括囊肿、腔外压迫、乳头状瘤、异位胰腺、鳞状上皮增生、黏膜内癌、食管鳞癌及胃腺癌等,占34.00%;所有超声胃镜小探头检查结果经术后病理结果证实,符合达到100%。结论将超声胃镜小探头应用于检查上消化道隆起性病变,可明确判定病变部位及性质,提高疾病诊断准确率,值得临床应用。     

胃镜检出胃恶性病变3460例分析

目的:探索胃镜检出胃恶性病变患者的发病及胃镜、病理特点。方法:对我院1990～2009年胃镜诊断的3460例胃恶性病变患者按不同年龄分组进行胃镜及病理资料的回顾性分析、总结。结果:3460例胃恶性病变患者中,男性多于女性(2.26∶1),但年龄≤40岁组男女差别不大。50岁以上发病明显增高,特别是60～70岁发病率最高。胃窦部为胃癌的高发部位,年龄≤40岁组以胃体和胃窦为主,而60岁以上患者胃贲门食管连接部癌的发病率显著上升。年龄≤40岁组病理类型以分化差、恶性程度高的低分化腺癌和印戒细胞癌为主,随着年龄增长,病理类型逐渐趋向于以中分化管状腺癌、高分化管状腺癌为主。胃淋巴瘤多发于胃体、胃窦部,胃镜下表现以多发性溃疡病灶为主。结论:胃恶性病变的发病与年龄、性别密切相关,不同年龄组胃癌的发生部位、病理特点各不相同,应引起重视,同时应提高对青年人胃癌的认识,提倡和重视胃镜检查普及,做到早期发现、早期诊断、早期治疗。     

老年上消化道隆起性病变电子内镜超声诊断与病理切片结果的差异分析

目的探讨电子内镜超声在老年上消化道隆起性病变诊断中的临床价值。方法老年上消化道隆起性病变患者98例,均进行超声内镜检查,比较超声内镜诊断准确率。结果 98例老年上消化道隆起性病变患者中,经超声内镜检查,按病变部位:胃65例(66.63%)、食管23例(23.47%)、十二指肠10例(10.20%);按病变范围:病灶直径1.0 cm 24例(24.49%)、1.0~2.0 cm者53例(54.08%)、2.0 cm者21例(21.43%);按病变类型:间质细胞瘤31例(31.62%)、平滑肌瘤23例(23.47%)、息肉22例(22.45%)、脂肪瘤10例(10.20%)、异位胰腺7例(7.14%)、囊肿3例(3.06%)、隆起糜烂性炎症2例(2.04%);与手术病理比较,超声内镜诊断准确为91.84%。结论经超声内镜检查,有助于判断老年上消化道隆起性病变的病灶分层及性质,可为临床治疗方式的选择提供可靠依据。     

内镜下食管黏膜碘染色对大连地区原居民早期食管癌的发现研究

目的 探讨经内镜进行食管黏膜碘染色方法对大连地区原居民早期食管癌的发现价值.方法 对45岁以上有上消化道症状的病人行胃镜检查时进行卢戈氏碘液的喷洒,对不染区进行多点病理活检.结果 有食管病变病人异常发现率为73.85%,癌前病变发生率为35.38%,早期食管癌发生率为1. 54%.结论 具有明显食管症状、内镜下发现食管黏膜可疑病变的病人,尽可能要进行碘染色和精确活检.对发现癌前病变的病人,要及时随访,反复碘染检查.大连地区原居民早期食管癌的发生率并不比全国发病率低.     

Gastrointestinal endoscopic evaluation of premenopausal women with iron deficiency anemia

GOALS: To evaluate whether the gastrointestinal tract could be a source of chronic blood loss in premenopausal women with iron deficiency anemia. BACKGROUND: While premenopausal women with iron deficiency anemia are typically managed with simple iron replacement, the standard of care for postmenopausal women and men is to exclude a gastrointestinal source of bleeding. STUDY: We identified 111 premenopausal women who underwent endoscopy for the sole indication of iron deficiency anemia. RESULTS: The mean age was 42.5 years. Lesions potentially causative of iron deficiency anemia were detected in 22 patients (20%). Upper gastrointestinal lesions were present in 14 patients (13%) and included only erosive lesions. Lower gastrointestinal lesions were detected in 8 patients (7.2%) and included colon cancer (2.7%), inflammatory bowel disease (3.6%), and a colonic ulcer >1 cm (0.9%). Patients with upper gastrointestinal lesions were more likely to use aspirin or nonsteroidal antiinflammatory drugs (11/14, 79%) than patients with no lesions (26/89, 23%; P = 0.043). Occult blood was more common in patients with lower gastrointestinal lesions 8/8 (100%) and patients with upper gastrointestinal lesions (9/14, 64%) than in patients without lesions (28/89, 31%; P = 0.037 and 0.039). Gastrointestinal symptoms were significantly more common in patients with gastrointestinal lesions than in patients without lesions. CONCLUSIONS: A gastrointestinal source of chronic blood loss was identified in a substantial proportion of premenopausal women with iron deficiency anemia. Patients with gastrointestinal symptoms, fecal occult blood, and/or weight loss should undergo endoscopy.     

超声内镜与CT仿真内镜对上消化道隆起样病变的诊断价值

目的 研究超声内镜(EUS)与CT仿真内镜(CTVE)对上消化道隆起样病变的诊断价值。方法 48例经胃镜检查发现有上消化道隆起样病变的患者(食管癌、胃癌、息肉等病例除外)，行CTVE和EUS检查，除9例检查发现为正常脏器外压、2例食管静脉瘤而密切随访观察外，其余均经手术或活检获取病理确诊。将以上三种方法诊断结果与病理结果进行比较。结果 胃镜、EUS、CTVE对上消化道隆起样病变的诊断准确率分别为16．7％、89．6％、66．7％，EUS、CTVE与胃镜检查结果差异有显著性(P＜0．001)；EUS、CTVE两者之间比较差异有显著性(P＜0．05)，EUS优于CTVE；EUS、CTVE对上述疾病的诊断的敏感性、特异性分别为89．7％、88．9％和66．7％、66.7％。结论 EUS和CTVE作为新兴的检查手段在对上消化道隆起样病变的诊断中有较高的临床实用价值，且两者有较强的互补性，可作为胃镜较难诊断的上消化道隆起样病变的确诊方法之一。     

内镜黏膜下剥离术治疗上消化道病灶的初步评价

目的 探讨内镜下黏膜剥离术(ESD)处理上消化道病灶的疗效和安全性.方法 以胃镜检查发现的上消化道黏膜病灶及黏膜下病灶作为入选对象,通过超声内镜和(或)活检病理检查明确病灶大小、位置、范围、性质,应用钩刀、IT刀、氩气刀及高频电凝电切术进行ESD操作,步骤包括:(1)胃镜及黏膜染色确定病灶,针刀或者氩气刀标记病灶;(2)黏膜下注射含靛胭脂及肾上腺素生理盐水抬高病变;(3)预切开病变周围黏膜一圈;(4)自病变黏膜下层完整剥离病灶.术后应用抑酸、黏膜保护剂治疗,术后第1、2、6个月内镜随访,评价溃疡是否愈合以及病灶有无残留与复发.结果 2006年8月至2008年1月,共153例患者进入观察研究.黏膜病变85例(溃疡型病灶2例,隆起型病灶48例,糜烂型病灶35例),病灶直径0.4～5.0 cm,平均2.0 cm;手术时间15～210 min.平均55min.所有病例均切除病灶,其中1例迟发性出血行内镜下紧急止血,7例穿孔均保守治疗愈合.随访期溃疡创面均愈合,其中4例复发,3例再次ESD完整切除病灶,1例手术切除.黏膜下肿瘤68例,52例术前行超声内镜检查,其余病例经术后病理证实.病灶直径0.4～4.0 cm,平均1.2 cm;手术时间10～182 min,平均41 min;68例完整剥离黏膜下肿瘤,1例改行尼龙绳结扎治疗.1 1例穿孔均保守治疗,1例术后出血未控制行手术治疗.结论 ESD作为一种微创治疗方法,能实现较大病变的一次性大块剥离,剥离的病变能提供完整的病理诊断资料,病变局部的复发率低,并发症少,为上消化道黏膜层病灶尤其是早期肿瘤以及黏膜下肿瘤的治疗开辟了新的途径.     

Esophagitis and gastroduodenal disorders associated with diabetic gastroparesis

The prevalence of associated gastrointestinal disorders with diabetic gastroparesis was studied retrospectively by reviewing all data on patients with diabetic gastroparesis who were admitted to the Hospital of the University of Pennsylvania, Philadelphia, over a four-year period. Twenty diabetic patients with intractable nausea and vomiting, thought to be secondary to diabetic gastroparesis, underwent upper gastrointestinal tract endoscopy after failure to respond to conventional therapy for gastroparesis within several days. Nine (45%) patients had normal upper endoscopic examination results. Eleven (55%) patients were discovered to have other gastrointestinal tract disorders that could explain their persistent symptoms of nausea and vomiting. Specifically, three patients had Candida esophagitis, four had erosive esophagitis, two had gastric ulcers, one had duodenal erosions, and one had bile reflux gastritis. These 11 patients improved when therapy was altered to treat their additional disorder. Management of diabetic gastroparesis is discussed with emphasis on early upper gastrointestinal tract endoscopy for patients who fail to respond to therapy initially.     

Upper gastrointestinal endoscopy in patients aged 85 years or more. Results of a feasibility study in a district general hospital

We performed a cross sectional analysis of the feasibility and yield of upper gastrointestinal endoscopy (UGE) in a cohort of patients aged 85 years or more. The study involved 218 patients who underwent diagnostic upper gastrointestinal endoscopy in a district general hospital between 1994 and 1998. Indication, use of sedation, endoscopic findings and treatment after endoscopy were evaluated. Indications for gastroscopy were suspicious of upper gastrointestinal bleeding (UGI) bleeding (41%), anemia (15%), and presence of dyspeptic- (31%), alarm- (9%) and/or reflux symptoms (3%). Serious UGI disease (cancer, peptic ulcer, reflux oesofagitis and/or erosive gastritis/duodenitis) was detected in 97 patients (44%). With respect to clinical presentation, serious UGI disease was present in 61% with bleeding, in 57% with reflux symptoms, in 42% with alarm symptoms, in 33% with anemia and in 28% with dyspepsia. Carcinoma was detected in eight patients (3.8%), all of them were treated with supportive care. In very old people gastroscopy is generally performed on sound indications reveals serious UGI disease in almost one out of two patients, markedly influences medical treatment, and reveals low malignancy rates (3.8%). In these patients, UGE is worthwhile and should not be omitted because of age considerations.     

Chronic Alcohol Abuse Leads to Gastric Atrophy and Decreased Gastric Secretory Capacity: A Histological and Physiological Study

We performed morphological and physiological studies in 43 male patients with alcohol dependence (ALC) who had no other apparent lesions in the upper gastrointestinal tract except atrophic and erosive gastritis. A gastric secretory study in which tetragastrin was used as the stimulant revealed that acid and pepsin secretion was less in ALC patients than in hospital controls (p less than 0.001). Endoscopic biopsy specimens of gastric mucosa from ALC patients revealed that atrophy of the gastric mucosa advanced with age. A strong negative correlation was also found between the secretory capacity of the stomach and the degree of atrophy. Possibly, the interval between recurrent episodes of acute mucosal damage was too short to allow complete healing of mucosal lesions. Failure to regenerate denuded epithelium would result in a decrease in the gastric secretory area. Thus, chronic alcohol abuse seems to be an etiological factor in atrophic gastritis.     

Is There a Role for Upper Gastrointestinal Endoscopy in the Evaluation of Patients with Occult Blood-Positive Stool and Negative Colonoscopy?

Objective: To determine the role of upper gastrointestinal endoscopy in the clinical investigation of patients with occult blood-positive and negative colonoscopy. Methods: This is a retrospectivc study of 211 consecutive patients who were investigated by upper gastrointestinal endoscopy for occult blood-positive stool and negative colonoscopy. Patients were categorized into four groups: asymptomatic (n = 117), symptomatic (n = 37), severe anemia (hemoglobin < 10 g/dl) (n = 33), and incomplete (CBC not obtained or insufficient documentation regarding the presence or absence of symptoms) (n = 24). Results: Eighty-eight of the 211 patients (42%) had abnormal upper gastrointestinal endoscopic findings: 43% of the "asymptomatic" group, 35% of the "symptomatic" group. 45% of the "severe anemia" group, and 42% of the "incomplete" group. The number of patients with abnormal upper gastrointestinal findings increased with age (p =0.0002). Furthermore, there was a significant difference in upper gastrointestinal lesions between the patients who were 60 yr of age or older, and the patients less than 60 yr of age: 51% compared to 22% (p = 0.00003). All upper gastrointestinal endoscopic findings were benign, with 53 of the 88 patients (60%) having erosive gastritis. However, only 25 of those 88 patients (28%) had a lesion for which a specific treatment was available. Conclusions: Upper gastrointestinal endoscopy in patients with occult blood-positive stool and negative colonoscopy has a very low yield for significant lesions, not only from a therapeutic standpoint, but also for detection of malignant lesions. Prospective studies are needed to determine which specific groups of patients deserve further investigation.     

Endoscopy for the diagnosis of acute upper gastrointestinal bleeding

Diagnostic gastroscopy was performed on 337 patients for acute upper gastrointestinal bleeding, with 88% (296 of 337) diagnostic accuracy. Peptic ulcer disease was the cause of bleeding in 43% of the cases, erosive gastritis in 16%, and oesophagitis in 11%. Of the 289 patients, 40% had associated lesions, the commonest being gastritis (31), hiatal hernia (24), oesophageal varices (16), and oesophagitis (16). An oesophageal site of the bleeding was most often detected in the patients under 50 years of age (p less than 0.001) and a gastric site among those over 70 years (p less than 0.05). Mallory-Weiss lesions were significantly more often the cause of bleeding among the youngest patients than in other age groups (p less than 0.001). The bleeding lesion was located in the stomach in 60% of the women and in 42% of the men (p less than 0.01) and in the duodenum in 13% and 28% (p less than 0.01), respectively. The principal causes of this difference was the high incidence of gastritis in the women and duodenal ulcer in the men.     

Relationship between gastric xanthoma,gastric precancerous lesions,and gastric cancer: A retrospective study

Objective

To evaluate the relationship between gastric cancer and its precancerous lesions and gastric xanthoma.

Methods

Medical records of 47 736 patients who underwent gastroscopy in our center from January 2020 to December 2021 were reviewed. Patients’ age, sex, endoscopic and histopathological findings, and the presence, number and location of gastric xanthoma were recorded. To investigate the detection rate of gastric xanthoma at different stages of gastric lesions, the participants were further divided into the chronic gastritis group (n = 42 758), the precancerous lesion group (n = 3672), and the gastric cancer group (n = 1306), respectively.

Results

The overall detection rate of gastric xanthoma was 2.85%, and it was most commonly observed in the gastric antrum (52.50%). In addition, gastric xanthoma was more common in men and more likely to be single lesion. It was most detected in the precancerous lesion group (8.39%), followed by the gastric cancer group (5.44%), and least in the chronic gastritis group (2.29%). Multivariate analysis showed that gastric xanthoma was closely related to precancerous lesions (odds ratio [OR] 3.197, 95% confidence interval [CI] 2.791–3.662, P < 0.001) and gastric cancer (OR 1.794, 95% CI 1.394–2.309, P < 0.001).

Conclusion

Gastric xanthoma is closely related to gastric precancerous lesions and gastric cancer.