放大内镜窄带成像对慢性胃炎的诊断价值

目的探讨放大内镜窄带成像对慢性胃炎的诊断价值。方法110例患者接受放大内镜窄带成像检查,根据Tahara分型将观察到的胃黏膜细微结构分为0型、Ⅰ型、Ⅱ型、Ⅲ型,并与相应部位活检的病理组织学进行比较分析。结果放大内镜窄带成像下胃黏膜超微结构与胃炎的组织病理五个指标均明显相关,且与炎症的严重程度相关。从0型到Ⅰ型、Ⅱ型、Ⅲ型,反映了慢性胃炎病变发展由轻到重的一个过程。其中萎缩、肠化主要见于Ⅲ型。结论放大内镜窄带成像下胃黏膜分型与病理组织学存在密切关系,通过放大内镜窄带成像准确识别胃黏膜超微结构将有助于对萎缩、肠化生等常见胃黏膜病变的诊断。     

Usefulness of magnifying endoscopy with narrow-band imaging for determining gastric tumor margin

Background and Aim: Magnifying endoscopy with narrow‐band imaging (ME‐NBI) enhances images of the irregular mucosal structures and microvessels of gastric carcinoma, and could be useful for determining the margin between cancerous and non‐cancerous mucosa. We evaluated the usefulness of ME‐NBI for determining the tumor margin compared with indigocarmine chromoendoscopy (ICC). Methods: The subjects were 110 patients (with 118 lesions) who underwent endoscopic submucosal dissection for gastric tumors. They were randomized into ME‐NBI and ICC groups. Marking was carried out by electrocautery with the tip of a high‐frequency snare at the tumor margins determined by each observation. The distance from the marking dots to the tumor margin was measured histopathologically in the resected specimens. Marking was diagnosed as accurate if the distance was less than 1 mm. Results: Of the 118 gastric lesions, 55 were allocated to the ME‐NBI group, and 63 to the ICC group. Seventeen lesions in the ME‐NBI group and 18 lesions in the ICC group were excluded because the distance from the marking dots to the tumor margin was immeasurable histopathologically. Thirty‐eight lesions in the ME‐NBI group and 45 lesions in the ICC group were evaluated. The rate of accurate marking of the ME‐NBI group was significantly higher than that of the ICC group (97.4% vs 77.8%, respectively; P‐value = 0.009). Conclusion: Magnifying endoscopy with narrow‐band imaging can identify gastric tumor margins more clearly than ICC.     

Usefulness of magnifying narrow-band imaging endoscopy for the diagnosis of gastric and colorectal lesions

A series of studies about the potential usefulness of magnifying endoscopy with narrow-band imaging (NBI) for the diagnosis of gastric and colonic lesion is reviewed. Concerning the magnifying NBI appearances of gastric lesions, a light blue crest is a highly accurate sign of the presence of histological intestinal metaplasia. Also, the degree of irregularity of the mucosal and vascular pattern is correlated with the histological severity of Helicobacter pylori-associated chronic gastritis. According to the 'VS classification', an irregular microvascular pattern and/or an irregular microsurface pattern together with a clear demarcation line are characteristic for early gastric carcinoma, and a multicenter prospective randomized controlled trial demonstrated that magnifying endoscopy with NBI is superior to ordinary white light endoscopy for making a differential diagnosis of a small depressed lesion between carcinoma and non-carcinoma. Concerning the magnifying NBI appearances of colonic tumor, the vague or invisible microvascular pattern is mostly observed in hyperplastic polyp. The regular meshed microvascular pattern is mostly observed in adenoma. The irregular meshed microvascular pattern is mostly observed in intramucosal or shallow submucosal-invasive carcinoma. The decreased or loose microvasucular pattern is mostly observed in deep submucosal-invasive carcinoma. Thus, magnifying NBI endoscopy is useful for the differentiation of colorectal non-adenomatous lesions from adenoma, the differentiation of adenoma from carcinoma, and the assessment of invasion depth of early colorectal carcinoma. At present, several magnifying NBI classifications for the diagnosis of early colorectal neoplasia have been proposed in Japan. Recently, the NICE classification based on NBI findings with/without magnification for colorectal tumor was established by an international group.     

放大内镜结合窄带成像技术在幽门螺旋杆菌相关性胃炎中的诊断价值

[目的]探讨放大内镜结合窄带成像技术(narrow-bandimaging magnification endoscopy,NBI-ME)在幽门螺旋杆菌(Helicobacter pylori,Hp)相关性胃炎中的诊断价值。[方法]选取360例在普通内镜下提示慢性胃炎的患者,行(14)~C呼气试验检测,并在NBI-ME下仔细观察胃窦部胃小凹形态和胃体下部大弯侧集合静脉形态,分析胃黏膜微细结构与Hp感染之间的联系。[结果]360例中有148例经(14)~C呼气试验检测诊断为Hp相关性胃炎。胃窦部大弯侧胃小凹形态分为B型、C型、D型、E型,Hp感染率分别是22.51%、83.63%、28.94%、9.52%,C型感染率最高,与B型、D型、E型比较均差异有统计学意义(P0.05),B型、D型、E型间比较差异无统计学意义;经抗Hp治疗后B型由治疗前的43例增加为治疗后的125例,而C型、D型和E型则分别减少74例、7例、1例,C型减少最多;B型、C型、D型、E型抗Hp有效率分别为55.41%、80.43%、63.64%、50.00%,C型有效率最高,与其他各型比较差异有统计学意义(P0.05)。胃体下部大弯侧集合静脉分为R型、I型、D型,Hp感染率分别为6.81%、62.22%、86.29%,其中D型、I型感染率明显高于R型(P0.05);经抗Hp治疗后R型由治疗前的13例增加为治疗后的119例,而I型、D型则分别减少17例、89例,D型减少最多;R型、I型、D型抗Hp有效率分别为71.62%、60.71%、83.18%,D型有效率最高,与R型、I型比较差异有统计学意义(P0.05)。[结论]NBI-ME能够清楚观察胃黏膜的细微结构及血管形态,从而对Hp相关性胃炎有较高的诊断价值。     

幽门螺杆菌感染时放大内镜下的胃黏膜改变

目的观察放大内镜直视下慢性胃炎患者幽门螺杆菌（Hp）感染时的胃黏膜微细形态变化.方法使用手动变焦电子放大内镜（Olympus GIF Q-240Z）,对190例有不同上消化道症状患者的胃体集合静脉和胃窦小凹形态进行放大观察,并在所观察部位活检作病理组织学检查及快速尿素酶检测,以研究两者之间的相互关系.结果放大内镜下胃体下段集合静脉分为规则型（R）、不规则型（Ⅰ）、消失型（D）三型,Hp感染率分别为6.0%、61.9%和72.4%,其中D型和Ⅰ型的Hp感染率明显高于R型（χ^2I=36.86,χ^2R=81.40,P值均＜0.01）.胃小凹形态分为A、B、C、D、E五型,中度以上炎症的发病率分别为10.0%、23.1%、68.9%、10.0%和4.6%.黏膜萎缩及肠上皮化生主要发生在C、D、E三型.黏膜萎缩发生率分别为26.2%、90.0%和95.5%;肠上皮化生发生率分别为11.5%、65.0%和95.5%.B、C、D三型存在Hp感染,其Hp感染发生率分别是29.0%（29/100）、66.7%（34/51）和33.3%（6/18）,三型间比较差异有统计学意义（χ^2C=19.71,P＜0.01;χ^2D=6.07,P＜0.05）.结论放大内镜下Hp感染的胃黏膜表现为集合静脉模糊、混乱或消失;胃小凹稀疏而粗大,开口扩张、表面发红.     

Prediction of submucosal gastric cancer by narrow-band imaging magnifying endoscopy

BackgroundThe features of gastric submucosal cancer revealed by magnifying endoscopy have not been reported. Aim of our study was to investigate whether magnifying endoscopy could contribute to the diagnosis of submucosal invasion.Patients and methodsIn this prospective, cross-sectional study, 197 lesions of gastric differentiated adenocarcinoma, diagnosed as mucosal cancer by conventional endoscopy, were observed by magnifying endoscopy with narrow-band imaging, paying attention to the presence of a blurry mucosal pattern and an irregular mesh pattern. After endoscopic submucosal dissection, all lesions were examined histologically and the areas of two features were estimated.ResultsAmong the lesions examined, 177 were diagnosed histologically as mucosal cancer and 20 as submucosal cancer. Multivariate logistic regression analysis confirmed that a blurry mucosal pattern (odds ratio 12.15, 95% confidence interval 3.45–42.76, p = 0.000) and an irregular mesh pattern (22.55, 4.22–120.45, p = 0.000) were independent predictors of submucosal invasion.ConclusionsNarrow band imaging magnifying endoscopic features are useful for predicting submucosal invasion in gastric cancer.     

Standard vs magnifying narrow-band imaging endoscopy for diagnosis of Helicobacter pylori infection and gastric precancerous conditions

BACKGROUNDAdvances in endoscopic imaging enable the identification of patients at high risk of gastric cancer. However, there are no comparative data on the utility of standard and magnifying narrow-band imaging (M-NBI) endoscopy for diagnosing Helicobacter pylori (H. pylori) infection, gastric atrophy, and intestinal metaplasia. AIMTo compare the diagnostic performance of standard and M-NBI endoscopy for H. pylori gastritis and precancerous conditions. METHODSIn 254 patients, standard endoscopy findings were classified into mosaic-like appearance (type A), diffuse homogenous redness (type B), and irregular redness with groove (type C). Gastric mucosal patterns visualized by M-NBI were classified as regular round pits with polygonal sulci (type Z-1), more dilated and linear pits without sulci (type Z-2), and loss of gastric pits with coiled vessels (type Z-3). RESULTSThe diagnostic accuracy of standard and M-NBI endoscopy for H. pylori gastritis was 93.3% and 96.1%, respectively. Regarding gastric precancerous conditions, the accuracy of standard and M-NBI endoscopy was 72.0% vs 72.6% for moderate to severe atrophy, and 61.7% vs. 61.1% for intestinal metaplasia in the corpus, respectively. Compared to type A and Z-1, types B+C and Z-2+Z-3 were significantly associated with moderate to severe atrophy [odds ratio (OR) = 5.56 and 8.67] and serum pepsinogen I/II ratio of ≤ 3 (OR = 4.48 and 5.69). CONCLUSIONClose observation of the gastric mucosa by standard and M-NBI endoscopy is useful for the diagnosis of H. pylori gastritis and precancerous conditions.     

放大内镜在幽门螺杆菌相关性胃炎诊断中的价值

目的：研究正常胃黏膜及幽门螺杆菌(Hp)相关性胃炎的放大内镜表现，探讨放大内镜对幽门螺杆菌相关性胃炎的诊断价值。方法：66例患者接受电子放大胃镜检查，观察胃体黏膜毛细血管网、胃小凹及集合小静脉，并取活组织行病理检查及进行Hp检测。结果：66例患者中Hp阳性者为36例，阴性者为30例。Hp阳性者中正常胃黏膜者2例，炎症者34例；Hp阴性者中，正常胃黏膜者28例，炎症者2例。Hp阳性者中，Z0型(见集合小静脉、网状真性毛细血管及针眼样的胃小凹)3例，Z1型(集合小静脉消失，毛细血管网正常或失去正常形态，胃小凹可见)8例，Z2型(集合小静脉及真性毛细血管网皆消失，扩张的胃小凹及沟回发白)15例，Z3型(扩张的胃小凹周围发红)10例；Hp阴性者中，Z0为27例，Z1为1例，Z2为2例，Z3为0例。结论：电子放大胃镜下观察到的胃体黏膜集合小静脉、毛细血管网、胃小凹是正常胃黏膜的特征，而它们的消失与变化是Hp相关性胃炎的特征。     

Mucosal patterns of Helicobacter pylori-related gastritis without atrophy in the gastric corpus using standard endoscopy

AIM:To identify the mucosal patterns of Helicobacter pylori(H.pylori )-related gastritis in the gastric corpus using standard endoscopy and to evaluate their reproducibility.METHODS:A total of 112 consecutive patients underwent upper gastrointestinal endoscopy.The endoscopists classified the endoscopic findings into 4 patterns.In the second part of the study,90 images were shown to 3 endoscopists in order to evaluate the inter-observer and intra-observer variability in image assessment.RESULTS:The mucosal p...     

蓝激光内镜联动成像模式对幽门螺杆菌感染相关性胃炎的诊断价值

目的 评价蓝激光内镜联动成像（LCI）观察模式在幽门螺杆菌（HP）感染相关性胃炎诊断中的价值。方法 2016年11月至2017年6月间,在南方医科大学深圳医院行蓝激光内镜检查诊断为慢性胃炎的40例患者作为研究对象,分别应用蓝激光内镜普通白光和LCI模式观察全胃黏膜外观形态,白光模式下依据慢性胃炎活检病理诊断共识取材,LCI模式下于异常发红部位取材,并行13碳尿素试验。使用Kappa分析检验2种方法与最终病理诊断的一致性,使用配对卡方检验分析2种方法间一致性的差异。结果 白光模式预测HP感染的阳性预测值为54.5％（6／11）,与最终病理诊断的一致性为0.475（19／40）,Kappa=0.635;LCI模式预测HP感染的阳性预测值为81.5％（22／27）,与最终病理诊断的一致性为0.875（35／40）,Kappa=0.741;配对卡方检验提示,预测结果与最终病理诊断的一致性2种内镜模式间差异有统计学意义（P＜0.01）。40例均行13碳尿素试验,阳性19例,其中1例LCI模式下活检病理诊断为HP阴性;13碳尿素试验阴性21例,其中4例LCI模式下活检病理诊断为HP阴性： 两者诊断一致性良好,Kappa=0.751。黏膜存在红白边界,白光模式0例、LCI模式15例;黏膜弥漫发红,白光模式0例、LCI 模式11例：白光模式下黏膜外观形态与蓝光LCI模式下黏膜外观形态相比较,经秩和检验提示差异具有统计学意义（Z=-4.455,P＜0.01）。结论 蓝激光内镜LCI观察模式较白光模式可明显提高HP感染相关性胃炎的诊断率,具有较好的临床使用价值。     

Role of magnifying narrow-band imaging endoscopy for diagnosis of Helicobacter pylori infection and gastric precancerous conditions: Few issues

Standard endoscopy with biopsy and narrow-band imaging with guided biopsy are techniques for the detection of Helicobacter pylori (H. pylori)-related gastritis and precancerous lesions. In this study, the authors compared standard endoscopy and magnified narrow-band imaging (commonly known as NBI-M) in the diagnosis of H. pylori infections, atrophic gastritis, and intestinal metaplasia. Although the sensitivity of NBI-M is better than standard endoscopy, the diagnostic accuracy did not differ substantially between the diagnostic modalities. Future prospective studies may guide endoscopists in difficult cases regarding which modality is more useful and cost-effective for the diagnosis of H. pylori-related gastritis and precancerous conditions.     

Helicobacter pylori-related chronic gastritis as a risk factor for colonic neoplasms

To summarize the current views and insights on associations between Helicobacter pylori(H. pylori)-related chronic gastritis and colorectal neoplasm, we reviewed recent studies to clarify whether H. pylori infection/H. pylori-related chronic gastritis is associated with an elevated risk of colorectal neoplasm. Recent studies based on large databases with careful control for confounding variables have clearly demonstrated an increased risk of colorectal neoplasm associated with H. pylori infection. The correlation between H. pylori-related chronic atrophic gastritis(CAG) and colorectal neoplasm has only been examined in a limited number of studies. A recent large study using a national histopathological database, and our study based on the stage of H. pylori-related chronic gastritis as determined by serum levels of H. pylori antibody titer and pepsinogen, indicatedthat H. pylori-related CAG confers an increased risk of colorectal neoplasm, and more extensive atrophic gastritis will probably be associated with even higher risk of neoplasm. In addition, our study suggested that the activity of H. pylori-related chronic gastritis is correlated with colorectal neoplasm risk. H. pylori-related chronic gastritis could be involved in an increased risk of colorectal neoplasm that appears to be enhanced by the progression of gastric atrophy and the presence of active inflammation.     

窄带成像放大内镜对胃良恶性溃疡的鉴别诊断价值

目的探讨窄带成像放大内镜对胃良恶性溃疡的鉴别诊断价值。方法对常规内镜检查诊断为胃良性溃疡者186例再行窄带成像放大内镜检查,观察溃疡边缘胃小凹及黏膜微血管改变,并于相应部位取活检做病理学检查。结果常规内镜诊断为胃良性溃疡者186例,窄带成像放大内镜检查诊断为良性溃疡174例,恶性溃疡者12例;良性溃疡胃小凹形态规则,149例（85．63％,149／174）为D型,23例（13．22％,23／174）为C型,2例（1．15％,2／174）为E型;恶性溃疡患者胃小凹形态不规则、大小不一,胃小凹基本形态均为F型（100％,12／12）。良、恶性溃疡小凹形态比较差异有显著性（P〈0．01）;76例良性溃疡患者溃疡边缘未见黏膜微血管（43．67％,76／174）,98例可见规则的血管网（56．33％,98／174）。11例恶性溃疡患者溃疡边缘可见不规则的血管（91．67％,11／12）。良恶性溃疡微血管形态比较差异有显著性（P〈0．01）。结论窄带成像放大内镜对胃良恶性溃疡的鉴别诊断有重要的参考价值。     

Mucin phenotype and narrow-band imaging with magnifying endoscopy for differentiated-type mucosal gastric cancer

Background  

Several studies have described the surface glandular structure in differentiated early gastric cancer observed by narrow-band imaging with magnifying endoscopy (NBI-ME) in two main patterns, i.e., a papillary or granular structure in an intralobular loop pattern (ILL) and a pit structure in a fine network pattern (FNP). However, it is uncertain why the NBI-ME findings of differentiated-type carcinomas are divided into two main patterns. We investigated the significance of the mucin phenotype in the morphogenetic difference between ILL and FNP.     

高清晰放大胃镜对幽门螺杆菌相关性胃炎胃粘膜表现的临床研究

目的：研究高清晰放大胃镜下幽门螺杆菌（Hp）相关性胃炎胃粘膜的特点，观察Hp感染根除治疗后胃粘膜的变化。方法：使用Fujinon EG485ZH85万像素高清晰放大电子胃镜，对50例门诊病例经常规胃镜检查后转换高清晰放大功能，详细观察胃体和胃窦粘膜的微细结构，判断Hp感染情况。结果：50例中Hp阳性26例，普通胃镜判断Hp感染的敏感性为34.62％，准确性为58.00％，阳性拟然比为2.08，阴性拟然比为0.78；高清晰放大胃镜判断Hp感染的敏感性为69.23％，准确性为78.00％，阳性拟然比为5.54，阴性拟然比为0.35。两种胃镜检查的Kappa值分别为0.176和0.563。结论：Hp相关性胃炎的胃镜下表现主要是胃小凹不均匀发红，小凹变粗、变宽，集合静脉的模糊、混乱或消失。高清晰放大胃镜判断Hp感染的准确性明显高于普通胃镜。     

Value of magnifying endoscopy with narrow-band imaging in diagnosis of 124 early gastric neoplastic lesions

<正>Objective To investigate the value of intervening part(IP)ratio under magnifying endoscopy with narrowband imaging(ME-NBI)in the diagnosis of early gastric neoplastic lesions.Methods From September 2012 to May 2015,a total of 124 patients with suspected superficial gastric neoplastic lesions under white light endoscope(WLI)were enrolled,87 male with mean age of(63.2±     

窄带成像放大内镜诊断胃黏膜上皮内瘤变的临床价值

目的探讨窄带成像放大内镜(NBI-ME)诊断胃黏膜上皮内瘤变的临床应用价值。方法选择2013-04~2015-08行普通白光胃镜(WLE)检查发现局灶性病变且自愿接受NIB-ME检查的100例患者作为研究对象,行NBI-ME检查观察病变的胃黏膜、毛细血管形态,并分别依据Sakami分型标准以及Yao分类标准对胃黏膜及毛细血管形态进行判断,之后对病变进行活检,将NBI-ME观察到的胃黏膜以及毛细血管形态分型与病理结果进行比较。结果经内镜检查显示,100例局灶性病变最终病理组织学证实炎症31例(31.0%),低级别上皮内瘤变44例(44.0%),高级别上皮内瘤变25例(25.0%),其中早期胃癌18例(18.0%)。WLE诊断上皮内瘤变的灵敏度、特异度、阳性预测值、阴性预测值、符合率分别为58.7%、35.3%、62.7%、29.3%、49.0%;NBI-ME诊断上皮内瘤变的灵敏度、特异度、阳性预测值、阴性预测值、符合率分别为84.4%、43.5%、83.3%、45.5%、75.0%,NBI-ME诊断胃黏膜上皮内瘤变的符合率明显高于WLE(75.0%vs49.0%,P0.05)。结论 NBI-ME在胃黏膜上皮内瘤变的诊断中具有较高的临床价值。     

Diagnosis of Helicobacter pylori‐related chronic gastritis,gastric adenoma and early gastric cancer by magnifying endoscopy

Evaluating the prevalence and severity of gastritis by endoscopy is useful for estimating the risk of gastric cancer (GC). Moreover, understanding the endoscopic appearances of gastritis is important for diagnosing GC due to the fact that superficial mucosal lesions mimicing gastritis (gastritis‐like lesions) are quite difficult to be detected even with optimum preparation and the best technique, and in such cases tissue biopsy is often not very accurate for the diagnosis of gastric epithelial neoplasia. Magnifying endoscopy is a highly accurate technique for the detection of early gastric cancer (EGC). Recent reports have described that various novel endoscopic markers which, visualized by magnifying endoscopy with image‐enhanced system (ME‐IEE), can predict specific histopathological findings. Using ME‐IEE with vessels and surface classification system (VSCS) may represent an excellent diagnostic performance with high confidence and good reproducibility to the endoscopists if performed under consistent conditions, including observation under maximal magnification. The aim of this review was to discuss how to identify high‐risk groups for GC by endoscopy, and how to detect effectively signs of suspicious lesions by conventional white light imaging (C‐WLI) or chromoendoscopy (CE). Furthermore, to characterize suspicious lesions using ME‐IEE using the criteria and classification of EGC based upon VSCS.     

Assessment of gastroesophageal reflux disease by serodiagnosis of Helicobacter pylori-related chronic gastritis stage

AIM:To evaluate the association of Helicobacter pylori(H.pylori)-related chronic gastritis stage with upper gastro-intestinal symptoms and gastro-eso-phageal reflux disease(GERD).METHODS:Subjects underwent upper gastrointestinal endoscopy,a questionnaire using a frequency scale for symptoms of GERD(FSSG),and measurements of serum H.pylori-antibody and pepsinogen(PG)levels.They were classified into the following 4 groups in terms of H.pylori-related chronic gastritis stage:Group A(n = 219),H.pylori(-)PG(-);Group B(n = 310),H.pylori(+)PG(-);Group C(n = 279),H.pylori(+)PG(+);and Group D(n = 17),H.pylori(-)PG(+).RESULTS:Reflux esophagitis occurred in 30.6% of Group A,14.5% of Group B,6.8% of Group C,and 0% of Group D(P < 0.001).Scores for acid reflux sympto-ms decreased significantly with chro-nic gastritis stage(from Group A to D)(P < 0.05),while scores for dysmotility symptoms did no-t differ significantly.The prevalence of nonerosive reflux disease(NERD)did not differ amo-ng groups.However,in subjects with GERD,the prevalence of NERD tended to increase with chronic gastritis stage(P = 0.081).CONCLUSION:Acid reflux sympto-ms and the prevalen-ce of reflux esophagitis can be assessed by measuring both serum H.pylori-antibody and PG levels.