Routine endoscopy using a magnifying endoscope for gastric cancer diagnosis

BACKGROUND AND STUDY AIMS: It has been reported that the fine mucosal patterns of the gastric pits can be observed with magnification and this may assist in preliminary evaluation prior to histological diagnosis. The aim of this prospective study was to clarify the relationship between the fine mucosal patterns of gastric lesions and histological findings, and also to evaluate the usefulness of magnifying endoscopy during routine endoscopy. PATIENTS AND METHODS: A recently developed magnifying video endoscope, which enables magnification up to 80 times, was used for gastrointestinal endoscopy in 318 patients between January 2000 and January 2001, at the National Shikoku Cancer Center. In total, 232 lesions were detected. However, patients diagnosed by conventional endoscopy as having advanced gastric cancer, malignant lymphoma, or submucosal tumor were excluded from the study. The endoscopic findings for 211 lesions included in this study were compared with the histological findings. RESULTS: Coarse and irregular mucosal patterns were observed in elevated-type cancers by magnifying endoscopy, and in depressed-type cancers there was a finer pit pattern than in the surrounding mucosa, destruction or disappearance of the mucosal microstructure, and abnormal capillary vessels. The magnifying endoscopy results were closely related to the mucosal microstructure observed by dissecting microscopy and to the histological features. The rate of presumptive diagnosis of small gastric cancers was significantly higher when a magnifying endoscope was used compared with conventional endoscopy. In this study, the sensitivity and specificity of magnifying endoscopy as a diagnostic method were 96.0% and 95.5%, respectively. CONCLUSIONS: The fine mucosal patterns and the features of capillary vessels, which were identified with the magnifying endoscope, correlated well with the pathological diagnosis. Magnifying endoscopy will be very useful in predicting the histological diagnosis during routine endoscopic procedures.     

结直肠癌患者内镜下黏膜剥离术前行超声内镜联合放大内镜检查的价值

目的 分析拟行内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)治疗的早期结直肠癌患者的临床资料,探讨ESD治疗前行超声内镜联合放大内镜检查的价值.方法 169例拟行ESD治疗的早期结直肠癌患者,其中72例治疗前行超声内镜联合放大内镜检查者为观察组,另97例直接行ESD者为对照...     

放大内镜在消化道疾病诊断中的应用研究进展

早在上世纪60年代，病理学家用解剖显微镜观察手术切除和活检标本，发现正常胃黏膜的微细形态可分为胃小凹及胃小沟等结构，当溃疡形成或黏膜癌变以后，这些微细形态可发生特征性的变化。内镜学家受此启发，期望内镜厂家能开发出具有解剖显微镜功能的放大内镜。     

放大胃镜对幽门螺杆菌相关性胃炎的诊断价值

目的探讨放大胃镜对幽门螺杆菌（helicobacterpylori,Hp）相关性胃炎的诊断价值。方法68例慢性浅表性胃炎患者接受了放大胃镜检查,观察胃体大弯集合静脉形态,取活检行病理检查,并进行Hp检测。结果68例患者中Hp阳性20例,Hp阴性48例。Hp阳性者中,18例（90%）表现为D型集合静脉,2例（10%）表现为I型集合静脉;Hp阴性者中,6例（12.5%）表现为D型集合静脉,42例（87.5%）表现为R型或I型集合静脉。两组之间比较,差异有显著性（χ^2为33.81,P〈0.001）。病理学检查结果显示：20例幽门螺杆菌阳性患者中,9例表现为轻度慢性炎症,11例表现为中度慢性炎症;48例幽门螺杆菌阴性患者中,43例表现为轻度慢性炎症或正常胃黏膜,5例表现为中度慢性炎症。两组间病理检查炎症程度差异有显著性（χ^2为13.22,P〈0.001）。结论Hp相关性慢性浅表性胃炎放大胃镜下特点为胃体集合静脉消失,其原因可能与黏膜炎症水肿有关。     

Usefulness of magnifying endoscopy in the diagnosis of early gastric cancer

BACKGROUND AND STUDY AIMS: We investigated the characteristic findings of early gastric cancer revealed by magnifying endoscopy, and clarified their relationship with histopathological features. PATIENTS AND METHODS: A total of 74 patients with early gastric cancer underwent magnifying endoscopy ( x 80) between March 2000 and December 2001. The endoscopic findings demonstrated 11 elevated-type carcinomas and 63 depressed-type, and histological examination showed 56 differentiated carcinomas and 18 undifferentiated carcinomas. The histopathological results were compared with findings from magnifying endoscopy regarding minute surface structure and microvessels. RESULTS: We were able to roughly classify the minute surface structure of early gastric cancer as shown by magnifying endoscopy into three patterns, as follows: (i). a small regular pattern of sulci and ridges; (ii). an irregular pattern of sulci and ridges; and (iii). a lack of visible structure. Abnormal microvessels observed in cancerous lesions were classified according to two patterns: irregular minute vessels and variation of vessel caliber. The small regular pattern of sulci and ridges was significantly more frequently observed in differentiated carcinoma (30/56, 53.6 %) than in undifferentiated carcinoma (2/18, 11.1 %). Lack of visible structure and irregular minute vessels were significantly more frequently observed in undifferentiated carcinoma (44.4 % and 77.7 %) than in differentiated carcinomas (5.4 % and 51.8 %). CONCLUSION: The minute surface structure and microvessels observed by magnifying endoscopy were related to histopathological findings. Magnifying endoscopy is valuable for predicting the histological nature in the diagnosis of early gastric cancer.     

Endoscopic findings of GERD

Reflux esophagitis is divided into four grades, i.e. Grade A to D, according to the severity of its mucosal break in the endoscopic classification of reflux esophagitis (Los Angels classification). In our study, only 14.3% of patients with heartburn had Grade A to D during endoscopy. This means that Los Angels classification is insufficient at least in Japan. Then we have claimed that Grade M and Grade N are to be included in this classification, which mean minimal change and no lesions, respectively.     

Endoscopic examination for the small bowel--video capsule endoscopy and double balloon enteroscopy

In 2001, the new endoscopic procedures for small bowel, video capsule endoscopy (VCE) and double balloon enteroscopy (DBE), were introduced in clinical routine. Those devices were the breakthrough for the imaging examination of small bowel. And each device has many different characteristics as the approach into the target organ. But the characteristic common to both is the ability having a total observation of small bowel with the high rate. The understanding of the small bowel disease is being deeper by diagnosis in collaboration with VCE and DBE recently. VCE is superior as the first examination for small bowel and DBE is useful for detailed examination and endoscopic therapy.     

放大内镜联合窄带成像在胃部早期肿瘤性病变患者中的应用效果

目的探讨放大内镜联合窄带成像(ME-NBI)在胃部早期肿瘤性病变患者中的应用效果。方法选取2013年1月-2016年6月于该院消化内镜中心行内镜检查的151例可疑胃早癌患者为研究对象,所有患者先行普通白光内镜(WLE)检查,然后行ME-NBI检查和靶向活检,重点测量腺管间质距离(以下简称腺间距),根据病理结果分为早癌组[高级别上皮内瘤变(HGIN)、黏膜内癌、黏膜下癌,n=72]和非早癌组[低级别上皮内瘤变(LGIN),n=79]。比较两组的基线资料和ME-NBI征象,采用受试者工作曲线下面积(AUC)来评价其对胃早癌的诊断价值。结果早癌组的边界线、不规则的黏膜微血管、不规则的表面腺管和腺间距升高的发生率明显高于非早癌组,差异有统计学意义(P0.05)。ME-NBI对胃早癌的AUC为0.947,高于WLE的0.832,具有较高的诊断价值,其灵敏度(Se)、特异度(Sp)、阳性预测值(PPV)、阴性预测值(NPV)和Youden指数分别为97.2%、84.8%、85.4%、97.1%和0.820。腺间距对胃早癌的AUC为0.907,高于传统微血管纹理与表面结构(VS)分型的0.889,且VS分型与腺间距进行联合诊断的AUC达到0.933,其Se、Sp、PPV、NPV和Youden指数分别为95.8%、83.5%、84.1%、95.7%和0.794。结论 ME-NBI是胃早癌的重要诊断方法,腺间距具有客观性强、简便易行和可重复性好的优点,能辅助传统VS分型来判断病变性质。     

Endoscopic examination for fistula

In 15 postoperative fistula cases, we performed endoscopic examination (fistuloscopy) and studied the clinical significance. The inside of the fistula was easily observed after irrigation with physiological saline. The drain was extubated in 6 cases in which cavities without abscesses were recognized. In a case of pancreatic fistula, the fistula was temporarily closed using fibrin glue. Re-operation was performed in a case in which recurrence of cancer was recognized by biopsy. On the other hand, in 9 cases in which cavities with abscesses were recognized, foreign bodies, such as suture threads, which were sources of infections were removed. Moreover, the drain was removed to the effective site, and the fistula then irrigated repeatedly. Consequently, with the exception of a death due to cancer and a case complicated by osteomyelitis, the fistula was closed in all cases. Fistuloscopy is a safe and easy technique. In addition, the method, which is less stressful for the patient, is considered to be effective for the examination and treatment of fistulas.     

Differential diagnosis of GERD

It was widely accepted that the prevalence of GERD is lower in Oriental countries compared to Western countries. But the incidence of GERD has recently increased in Japan. The most commonly recognized manifestation of GERD is heartburn or a substernal burning sensation in the chest. Most patients with reflux esophagitis complain of typical symptoms such as heartburn, regurgitation or dysphagia. However, some patients complain of atypical symptoms such as hoarse voice, chronic cough, adult-onset asthma or vocal cord polyps. It is not always easy to diagnose atypical symptomatic patients as GERD. If patients who complain of these atypical symptoms have not improved with common medical treatment, GERD should be the consideration in its differential diagnosis.     

Endoscopic examination for pancreatic fistula

We have conducted endoscopic examination in 5 cases of postoperative pancreatic fistula, and discuss its clinical significance. The examination provided not only an observation of the fistula but also opportunity to irrigate the fistula for removal of foreign substances. The biopsy permitted histological examination for necrotic substances and the fistulous wall. Endoscopy made it easy to introduce a drain into the affected site and to judge when to remove the drain. Closure of the fistula was also attainable using fibrin glue. Consequently, the fistulas were closed within 1 month from the examination in all cases but one, in which death resulted due to carcinoma. The examination is an easy and safe technique.     

Diagnosis of Barrett's esophagus and Barrett's carcinoma using magnifying endoscopy

Specialized columnar epithelium (SCE) in Barrett's esophagus has been detected by random or four quadrant biopsy using conventional endoscopy; however little is known about the fine mucosal structure of SCE. The fine mucosal pattern (pit pattern) was classified into five categories. Tubular or villous pit patterns were not only characteristics of both SCE and methylene blue absorption but also possessed intestinal mucin phenotype. Targeted biopsy under the magnifying chromo-endoscopy might contribute to the early detection of Barrett's cancer.     

Comparison of white-light endoscopy,optical-enhanced and acetic-acid magnifying endoscopy for detecting gastric intestinal metaplasia: A randomized trial

BACKGROUNDGastric intestinal metaplasia (GIM) is a precancerous lesion of the stomach, which severely affects human life and health. Currently, a variety of endoscopic techniques are used to screen/evaluate GIM. Traditional white-light endoscopy (WLE) and acetic-acid chromoendoscopy combined with magnifying endoscopy (ME-AAC) are the interventions of choice due to their diagnostic efficacy for GIM. Optical-enhanced magnifying endoscopy (ME-OE) is a new virtual chromoendoscopy technique to identify GIM, which combines bandwidth-limited light and image enhancement processing technology to enhance the detection of mucosal and vascular details. We hypothesized that ME-OE is superior to WLE and ME-AAC in the evaluation of GIM.AIMTo directly compare the diagnostic value of WLE, ME-AAC, and ME-OE for detection of GIM.METHODSA total of 156 patients were subjected to consecutive upper gastrointestinal endoscopy examinations using WLE, ME-AAC, and ME-OE. Histopathological findings were utilized as the reference standard. Accuracy, sensitivity, specificity, and positive and negative predictive values of the three endoscopy methods in the diagnosis of GIM were evaluated. Moreover, the time to diagnosis with ME-AAC and ME-OE was analyzed. Two experts and two non-experts evaluated the GIM images diagnosed using ME-OE, and diagnostic accuracy and intra- and inter-observer agreement were analyzed.RESULTSGIM was detected in 68 of 156 patients (43.6%). The accuracy of ME-OE was highest (91.7%), followed by ME-AAC (86.5%), while that of WLE (51.9%) was lowest. Per-site analysis showed that the overall diagnostic accuracy of ME-OE was higher than that of ME-AAC (P = 0.011) and WLE (P < 0.001). The average diagnosis time was lower in ME-OE than in ME-AAC (64 ± 7 s vs 151 ± 30 s, P < 0.001). Finally, the inter-observer agreement was strong for both experts (k = 0.862) and non-experts (k = 0.800). The internal consistency was strong for experts (k = 0.713, k = 0.724) and moderate for non-experts (k = 0.667, k = 0.598).CONCLUSIONFor endoscopists, especially experienced endoscopists, ME-OE is an efficient, convenient, and time-saving endoscopic technique that should be used for the diagnosis of GIM.     

窄带谱成像放大内镜技术对早期食管癌及其癌前病变诊断的临床应用价值*

目的探讨窄带谱成像放大内镜(NBI-ME)观察下食道病变上皮乳头内血管袢(IPCL)分型对早期食管癌(EEC)及癌前病变诊断的临床价值。方法回顾该院内镜诊治中心2013年7月-2016年12月发现的食管黏膜表面异常的102例(共132处病变)患者内镜表现和临床病理资料,分析IPCL分型对食道病变性质及浸润深度的预判作用。结果 IPCL为A型的病变中95.0%(38/40)病理诊断为食管炎,IPCL为B型的病变中96.7%(89/92)病理诊断为EEC及癌前病变;NBI-ME观察后,术前活检病理与术后完整病理一致性尚可(Kappa=0.4850.4,P 0.01);B1、B2、B3型IPCL预判食道病变浸润深度的准确率分别为68.0%(34/50)、73.3%(11/15)及100.0%(4/4)。结论 NBI-ME观察下对食道病变的IPCL进行AB分型,有助于对食管病变性质及浸润深度的预判,同时结合病理结果及超声内镜(EUS)等技术,可实现对病变病情的综合评估,从而可以为患者制定最佳的治疗策略。     

放大内镜诊断大肠黏膜病变

目的通过放大内镜观察不同大肠黏膜病变的pit形态，探讨其用于诊断肿瘤性病变与非肿瘤性病变的准确性，研究大肠癌前病变及早期大肠癌的放大内镜下特点及其与浸润深度的关系。方法放大内镜观察病变表面结构，与病理准断结果进行对照研究。结果放大内镜诊断非肿瘤性病变（增生性、炎性、肥大赘生物）和肿瘤性病变（腺瘤和癌）的病理符合率分别为82．19％和96．05％。11个癌变病变中（8个黏膜内癌、2个黏膜下层癌、1个进展期癌），10个出现了Ⅴ型结构。30个病变同时进行了实体显微镜观察。结论放大内镜通过对pit形态的观察可以很好地区分非肿瘤性病变和肿瘤性病变。出现ⅤA型pit者多为黏膜内癌，出现ⅤN型者可能为黏膜下层癌或进展期癌。放大内镜与实体显微镜观察息肉pit形态，其结果基本一致。     

X-ray examination of endoscopy?

One hundred and one consecutive patients with upper abdominal dyspepsia were examined by conventional barium meal, double contrast examination, and endoscopy of the stomach and the duodenum in a blind prospective investigation. All the examiners were specially trained. Only small differences between the sensitivity and the specificity of the methods were found, but the clinical importance of the false positive and the false negative errors of the three methods of examination was not the same. The sensitivity of the ordinary X-ray examination was found to be sufficiently high for still recommending this method for primary screening. In case of positive findings in the stomach, supplementary gastroscopy ought to be performed in order to increase the diagnostic specificity.     

高清智能电子染色内镜联合放大内镜对食管早癌及癌前病变的诊断价值

目的探讨高清智能电子染色内镜（i-Scan）联合放大内镜对食管早癌、癌前病变的诊断价值。方法选取我院经病理学检查证实为食管早癌患者100例（早癌组）、200例发生食管癌癌前病变（癌前病变组）的患者的内镜检查资料进行数据分析,以病理学结果作为金标准,计算i-Scan联合放大内镜下、白光内镜单独及联合应用时诊断食管早癌及癌前病变的检出率及诊断指标。结果i-Scan对食管早癌的诊断检出率为88.00%,癌前病变检出率为82.50%,轻度不典型增生检出率为28.00%,中度不典型增生检出率29.00%;白光内镜对食管早癌的诊断检出率为57.00%,癌前病变检出率为56.00%,轻度不典型增生检出率为16.00%,中度不典型增生检出率为17.00%;i-Scan对上述病变的检出率均高于白光内镜,差异具有统计学意义（P < 0.05）。i-Scan对食管黏膜重度不典型增生检出率（25.50%）与白光内镜（22.50%）比较,差异无统计学意义（P>0.05）;i-Scan联合放大内镜检查对100例食管早癌患者、200例食管癌前病变患者诊断的IPCL分型与病理类型对比,结果显示：100例食管早癌患者中有12例诊断为A型、将中度不典型增生患者中的2例诊断为B1型,将重度不典型增生患者中的4例诊断为B1型;白光内镜鉴别诊断食管早癌、食管癌癌前病变的敏感度为57.00%,特异性为56.00%;i-Scan鉴别诊断食管早癌、食管癌癌前病变的敏感度为88.00%,特异性为82.50%;i-Scan联合放大内镜检查鉴别诊断食管早癌、食管癌癌前病变的敏感度为88.00%,特异性为97.00%。结论iScan联合放大内镜对食管早癌、癌前病变的鉴别诊断具有较高的敏感度和特异性。