窄带成像放大内镜下食管黏膜微血管形态观察的临床价值

目的探讨窄带成像放大内镜(NBI-ME)技术在食管黏膜微血管形态分型及其临床价值。方法应用NBI-ME技术对52例食管病变患者进行检查,观察食管黏膜上皮乳头内毛细血管袢(intraepithelial papillary capillary loop,IPCL)形态,并于各不同形态处行活组织检查。结果食管炎的IPCL主要呈Ⅱ型,为88.00%,低级别黏膜内瘤变的IPCL呈Ⅱ、Ⅲ型,Ⅱ型为43.75%,Ⅲ型为56.25%,高级别黏膜内瘤变的IPCL主要呈Ⅲ型,为83.33%,食管癌的IPCL主要呈Ⅳ型,为100%。结论通过NBI-ME对4种食管黏膜IPCL的形态观察可以推测病理组织学诊断,提高镜下诊断早期食管癌及癌前病变的准确率,以指导正确的治疗方法及镜下随诊。     

放大内镜窄带成像对于胃神经内分泌肿瘤的诊断价值

目的:分析运用白光内镜(WLI)及放大内镜窄带成像(ME-NBI)诊断胃神经内分泌肿瘤(G-NENs)的特点并探讨其临床诊断价值。方法:选择2017年1月-2021年6月西安市人民医院收治的36例G-NENs患者(观察组)及同期收治的40例胃息肉患者(对照组)临床资料,分析观察组临床病理特点及2组病变ME-NBI特点。结果:WLI结合ME-NBI诊断G-NENs敏感性为80.6%,特异性为90.0%,阳性预测值为87.9%,阴性预测值为83.7%,准确度为85.5%,约登指数为0.71。结论:WLI结合ME-NBI有利于观察G-NENs表面特异性的腺体结构改变及上皮下黑棕色迂曲增粗的螺旋状血管,对于鉴别G-NENs及胃息肉有重要意义,能够针对性地对病灶进行靶向活检,避免漏诊及误诊,并对正确治疗方式选择提供帮助。     

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。     

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。     

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。     

白光内镜、放大内镜及放大内镜联合窄带成像技术对早期胃癌的诊疗价值

背景 胃癌是我国常见的消化道恶性肿瘤之一,进展期胃癌患者5年生存率不到20％,而早期胃癌(EGC)患者5年生存率高于90％.放大内镜(ME)联合窄带成像技术(NBI)有助于EGC的诊断,也有利于指导进一步治疗.目的 比较白光内镜、ME及ME联合NBI对EGC的诊疗价值.方法 选取2017年6月—2019年5月邢台市人民...     

放大内镜结合窄带成像对胃浅表隆起性低级别腺瘤与早期胃癌的诊断价值

目的研究放大内镜结合窄带成像(M-NBI)对胃浅表隆起性低级别腺瘤与早期胃癌的诊断价值。方法选取2016-09～2018-05于郑州大学第二附属医院行无痛胃镜检查的53例胃浅表隆起性病变的患者,分别采用白光成像(C-WLI)和M-NBI对同一患者进行诊断,分析和比较两种方法的灵敏度、特异度和准确度。结果 C-WLI的诊断灵敏度、特异度和准确度分别为64. 0%、90. 0%、72. 0%; M-NBI的诊断灵敏度、特异度和准确度分别为94. 0%、90. 0%和93. 0%。结论 M-NBI有助于鉴别浅表隆起性胃癌和腺瘤。     

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。     

窄带成像技术结合放大内镜在早期胃癌诊断中的价值研究

目的评价窄带成像技术（NBI）结合放大内镜在早期胃癌诊断中的应用价值。方法2008年3月至2008年12月经普通内镜发现存在胃黏膜可疑病灶且符合研究要求的患者共56例,行NBI结合放大内镜及靛胭脂染色检查,对NBI、靛胭脂染色诊断的胃黏膜腺管及微血管形态的清晰程度评分进行比较。内镜检查之后对所检查部位进行靶向活检,将NBI结合放大内镜及靛胭脂染色检查结果及病理检查结果进行比较。结果56例中有16例经病理诊断为早期胃癌。将NBI结合放大内镜及靛胭脂染色检查结果及病理检查结果进行统计得出：NBI结合放大内镜诊断早期胃癌的诊断符合率、敏感性、特异性、假阳性率、假阴性率分别为94．6％（53／56）、93．8％（15／16）、95．0％（38／40）、5．0％（2／40）、6．3％（1／16）;靛胭脂染色诊断早期胃癌的诊断符合率、敏感性、特异性分别为91．1％（51／56）、87．5％（14／16）、92．5％（37／40）,假阳性率、假阴性率分别为7．5％（3／40）、12．5％（2／16）;二者比较差异均无统计学意义（P均〉0．05）。NBI、靛胭脂染色诊断的胃黏膜腺管及微血管形态的清晰程度评分结果对比显示：NBI与靛胭脂染色在腺管结构显示方面无明显差别,但NBI显示微血管形态明显优于靛胭脂染色。结论NBI结合放大内镜可以提供清晰的胃黏膜血管图像,有助于早期胃癌的诊断,可提高活检检查的准确性,与靛胭脂染色联用可提高早期胃癌的诊断率。     

Topographic differences in gastric micromucosal patterns observed by magnifying endoscopy with narrow band imaging

Background and Aim: The distributions and grades of Helicobacter pylori induced gastritis are known to vary among H. pylori‐associated diseases. The aim of this study was to investigate the differences in distributions of gastric micromucosal structures observed by magnifying narrow band imaging (NBI) endoscopy among patients with different H. pylori‐associated diseases. Methods: Ninety‐five patients with active duodenal ulcers (n = 24) and diffuse‐type (n = 24) and intestinal‐type (n = 47) early gastric cancers were enrolled. The magnified NBI findings were evaluated at the lesser and greater curvatures in the upper gastric corpus and were classified according to the modified A‐B classification system. Biopsy specimens were also evaluated. Results: In a total of 190 areas observed with magnifying NBI, histological grading (inflammation, activity, atrophy and intestinal metaplasia) showed significant differences among the classified micromucosal patterns (P < 0.001). Types B‐1 and B‐2, with mild atrophic changes and few areas of intestinal metaplasia, were seen mostly in the duodenal ulcers group. Types B‐3 and A‐1, with moderate atrophic changes, were seen in the diffuse‐type early gastric cancers at the lesser curvature. Types A‐1 and A‐2, with severe atrophic change and a high frequency of intestinal metaplasia, were seen in the intestinal‐type early gastric cancers at the lesser curvature. The prevalence of micromucosal structures differed significantly among the three groups both at the lesser and greater curvatures (P < 0.001). Conclusions: Magnifying NBI endoscopy clearly revealed detailed micromorphological differences corresponding to the histology and endoscopic findings among patients with different H. pylori‐associated diseases.     

Two cases of adenocarcinoma occurring in sporadic fundic gland polyps observed by magnifying endoscopy with narrow band imaging

Gastric fundic gland polyps(FGPs) are common nonadenomatous gastric polyps arising from normal fundic mucosa without Helicobacter pylori(H. pylori) infection. Although systemic FGPs associated with familial adenomatous polyposis(FAP) often have dysplasia, there are few reports of dysplasia occurring in sporadic F G P s, e s p e c i a l l y w h e n d e t e c t e d b y m a g n i f y i n g endoscopy with narrow band imaging(ME-NBI). We experienced two cases of adenocarcinoma occurring in sporadic FGPs, and their ME-NBI findings were very useful for differentiating FGP with cancer from nondysplastic FGP. A 68-year-old man and a 63-year-old woman were referred to our institution for medical checkup. H. pylori was negative in both patients. Endoscopic examination revealed a small reddishpolypoid lesion on the anterior wall of the upper gastric body and several FGPs. ME-NBI showed an irregular microvascular architecture composed of closed loop- or open loop-type vascular components, plus an irregular microsurface structure composed of oval-type surface components which was different from that of FGPs. FAP was denied because of the absence of colon polyps and no familial history of FAP. Pathological diagnosis was adenocarcinoma occurring in sporadic FGP.     

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.     

普通白光联合窄带光成像放大内镜检查诊断早期胃癌浸润深度的模型研究

目的分析早期胃癌(EGC)黏膜下浸润的特征表现,通过联合白光内镜及窄带光成像结合放大内镜(ME-NBI)检查提高EGC浸润深度诊断的准确性。方法回顾性分析2015年1月至2017年12月期间因术前怀疑EGC于北京友谊医院行内镜黏膜下剥离术或外科手术治疗的患者资料。收集患者基本信息、病灶特征及术后病理等信息,分析EGC黏膜下浸润的特征、黏膜下浸润的独立危险因素,构建预测EGC浸润深度的模型。结果195例患者(207处病灶)纳入研究。207例病灶以2:1比例随机分为建模组(138处)及测试组(69处)。在建模组,病灶位于胃上1/3(0K=12.949,95%CZ:2.148~7&070,P=0.005),胃中1/3(OR=7.534,95%C/:1.044~54.360,P=0.045),病灶长径>2 cm(OR=6.828,95%C/:1.657~28.136,P=0.008)及存在扩张血管(OR=6.856,95%C/:1.577~29.805,P=0.010)是病灶黏膜下浸润的独立危险因素。根据上述独立危险因素构建浸润深度预测评分系统(DPSS)(病灶位于胃上1/3、病灶位于胃中1/3、病灶长径>2 cm、存在扩张血管各为5分、4分、4分、4分)。在建模组及测试组,DPSS预测病灶黏膜下浸润的受试者工作特征曲线下面积分别为0.884(95%C/:0.809-0.960)及0.799(95%C/:0.684~0.914)0界值为8分时,建模组及测试组诊断敏感度分别为83.3%、71.4%,特异度分别为76.2%,74.5%o结论联合普通白光内镜及ME-NBI建立的DPSS可以较好地预测EGC浸润深度。     

Investigation of relationships among gastroesophageal reflux disease subtypes using narrow band imaging magnifying endoscopy

AIM:To investigate the relationships among subtypes of gastroesophageal reflux disease(GERD)using narrow band imaging(NBI)magnifying endoscopy.METHODS:A reflux disease questionnaire was used to screen 120 patients representing the three subtypes of GERD(n=40 for each subtypes):nonerosive reflux disease(NERD),reflux esophagitis(RE)and Barrett’s esophagus(BE).NBI magnifying endoscopic procedure was performed on the patients as well as on 40 healthy controls.The demographic and clinical characteristics,and NBI magnifying endoscopic features,were recorded and compared among the groups.Targeted biopsy and histopathological examination were conducted if there were any abnormalities.SPSS 18.0 software was used for all statistical analysis.RESULTS:Compared with healthy controls,a significantly higher proportion of GERD patients had increased number of intrapapillary capillary loops(IPCLs)(78.3%vs 20%,P<0.05),presence of microerosions(41.7%vs 0%,P<0.05),and a non-round pit pattern below the squamocolumnar junction(88.3%vs 30%,P<0.05).The maximum(228±4.8 vs 144±4.7,P<0.05),minimum(171±3.8 vs 103±4.4,P<0.05),and average(199±3.9 vs 119±3.9,P<0.05)numbers of IPCLs/field were also significantly greater in GERD patients.However,comparison among groups of the three subtypes showed no significant differences or any linear trend,except that microerosions were present in 60%of the RE patients,but in only 35%and 30%of the NERD and BE patients,respectively(P<0.05).CONCLUSION:Patients with GERD,irrespective of subtype,have similar micro changes in the distal esophagus.The three forms of the disease are probably independent of each other.     

Esophageal adenocarcinoma with white opaque substance observed by magnifying endoscopy with narrow band imaging

White opaque substance (WOS) is observed in the gastric neoplasia of 0‐IIa type using magnifying endoscopy with narrow band imaging (NBI‐ME). Colonic and duodenal neoplasms with WOS have also been reported. Immunohistochemical examination with adipophilin reveals WOS in gastric neoplasms as lipid droplets, and WOS is specific for neoplasm with intestinal or gastrointestinal phenotype. We herein report a case of adenocarcinoma of the esophagogastric junction with WOS. A male patient in his sixties was found by esophagogastroduodenoscopy to have an esophageal elevated lesion. NBI‐ME showed whitish deposits that looked similar to WOS in gastric neoplasms. The patient underwent endoscopic submucosal dissection and the lesion was resected in a single piece. This tumor had diffuse positivity for adipophilin and gastrointestinal phenotype.     

放大内镜在胃部疾病诊断中的应用

放大内镜在消化道疾病尤其胃癌及癌前病变的诊断方面有着独特优势,并能指导活检,避免不必要的活检创伤,有着普通内镜所不能比拟的优势.本文对近年来放大内镜在胃部疾患的应用进展作一综述,同时结合临床操作体会,总结放大内镜的操作要领.     

放大内镜联合端粒酶逆转录酶对胃癌前病变的诊断价值

目的探讨放大内镜和人端粒酶逆转录酶（hTERT）在胃黏膜癌前病变中的诊断价值。方法应用放大内镜对154例病人进行检查,放大内镜下做出实时诊断,取活组织分别送病理学检查和实时荧光定量PCR检测hTERTmRNA的表达。放大内镜下胃小凹分为A、B、C、D、E5型。A型：圆点状小凹;B型：线状小凹;C型：稀疏而粗大的线状小凹;D型：斑块状;E型：绒毛状。结果放大内镜下B—E4种胃小凹形态肠上皮化生发生率差异有统计学意义（X^2=17．58,P〈0．05）,并且肠上皮化生的严重程度逐渐加重（Pearson列联系数=0．531,P〈0．05）;C—E3种胃小凹形态与不典型增生的严重程度关系密切（X^2=10．256,Pearson列联系数=0．549,P〈0．05）;B、C、D、E4型胃小凹形态间hTERT mRNA表达量差异有统计学意义（F=3．274,P〈0．05）。若以胃癌中hTERT mRNA表达量作为胃癌的诊断标准,病理未诊断为胃癌而放大内镜下表现为E型胃小凹的病人中65％符合该标准。结论放大内镜下胃黏膜微细结构形态可反映病变程度的轻重;hTERT是一重要的胃癌标志物,随访E型胃小凹和高hTERT表达的患者有助于早期发现胃癌。