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。     

A feasibility trial of narrow band imaging endoscopy in patients with gastroesophageal reflux disease

BACKGROUND AND AIMS: Narrow band imaging (NBI) endoscopy system enhances visualization of microvasculature and mucosal patterns. This study assessed the utility of NBI in patients with gastroesophageal reflux disease (GERD) symptoms. METHODS: Patients with and without GERD symptoms completed 2 validated GERD questionnaires prior to enrollment. The distal esophagus was examined by standard white light endoscopy followed by NBI. The features seen only by NBI were compared between GERD patients and controls. RESULTS: Overall, 80 patients (50 GERD, 30 controls) were eligible for final analysis (mean age, 58.4 years; males, 93.7%; white, 82.5%). A significantly higher proportion of patients with GERD had increased number (OR, 12.6; 95% CI: 3.7-42; P < .0001), dilatation (OR, 20; 95% CI: 6.1-65.3; P < .0001), tortuosity of intrapapillary capillary loops (IPCLs) (OR, 6.9; 95% CI: 2.5-19; P < .0001), presence of microerosions (P < .0001), and increased vascularity at the squamocolumnar junction (OR, 9.3; 95% CI: 1.9-43.6; P = .001) compared with controls. On multivariate analysis, increased number (OR, 5.5; 95% CI: 1.4-21.6) and dilatation (OR, 11.3; 95% CI: 3.2-39.9) of IPCLs were the best predictors for diagnosing GERD. The maximum, minimum, and average number of IPCLs/field were significantly greater in the GERD group compared with controls (P < .0001). Although the interobserver agreement for the various NBI findings was very good, the intraobserver agreement was modest. CONCLUSIONS: NBI endoscopy may represent a significant improvement over standard endoscopy for the diagnosis of GERD. These preliminary findings including inter- and intraobserver agreement need to be evaluated in future prospective, controlled, and blinded GERD trials.     

窄带成像放大内镜下胃小凹形态观察的临床价值

目的探讨窄带成像放大内镜(NBI)技术下胃小凹的形态分型及其临床价值。方法应用窄带成像放大内镜技术对113例患者进行检查,观察胃小凹形态,并于各不同形态处行活组织检查。结果 A、B型胃小凹主要见于慢性浅表性胃炎,C、D、E型胃小凹主要见于慢性萎缩性胃炎,D、E型胃小凹与肠上皮化生及异型增生密切相关。结论通过窄带成像放大内镜对5种胃小凹的形态观察可以推测病理组织学诊断,使镜下准确诊断胃黏膜萎缩、肠上皮化生及异型增生成为可能,以指导正确的治疗方法及内镜下随诊。     

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。     

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.     

Diagnosis of early gastric cancer using narrow band imaging and acetic acid

AIM: To determine whether the endoscopic findings of depressed-type early gastric cancers(EGCs) could precisely predict the histological type.METHODS: Ninety depressed-type EGCs in 72 patients were macroscopically and histologically identified. We evaluated the microvascular(MV) and mucosal surface(MS) patterns of depressed-type EGCs using magnifying endoscopy(ME) with narrow-band imaging(NBI)(NBI-ME) and ME enhanced by 1.5% acetic acid, respectively. First, depressed-type EGCs were classified according to MV pattern by NBI-ME. Subsequently, EGCs unclassified by MV pattern were classified according to MS pattern by enhanced ME(EME) images obtained from the same angle.RESULTS: We classified the depressed-type EGCs into the following 2 MV patterns using NBI-ME: a fine-network pattern that indicated differentiated adenocarcinoma(25/25, 100%) and a corkscrew pattern that likely indicated undifferentiated adenocarcinoma(18/23, 78.3%). However, 42 of the 90(46.7%) lesions could not be classified into MV patterns by NBI-ME. These unclassified lesions were then evaluated for MS patterns using EME, which classified 33(81.0%) lesions as MS patterns, diagnosed as differentiated adenocarcinoma. As a result, 76 of the 90(84.4%) lesions were matched with histological diagnoses using a combination of NBI-ME and EME.CONCLUSION: A combination of NBI-ME and EME was useful in predicting the histological type of depressedtype EGC.     

超声引导下甲状腺结节细针穿刺术后病人舒适度的研究及护理对策

[目的]为了解超声引导下甲状腺结节细针穿刺(FNA)术后病人不舒适的相关因素,有针对性地加强对术后病人不舒适的护理。[方法]抽取本科8月份FNA术后病人136例,采用中文版舒适量表进行调查。内容包括一般资料、FNA检查的不适反应及程度。[结果]病人术后不舒适的原因有恶心、呕吐、头晕、喉咙痛等方面。检查期间轻度不适72.06%,中度不适24.26%,重度不适3.68%。[结论]针对病人不同程度的不适反应,制定具体的护理对策,实施相应的护理措施,有效解决病人的不适,减轻病人的恐惧心理,提升病人的舒适度。     

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.     

放大内镜下胃食管反流性疾病的临床研究

目的应用放大胃镜观察胃食管反流病内镜下表现，探讨其特征性微细结构表现。方法66例胃食管反流性疾病者（非糜烂性食管炎NERD44例、糜烂性食管炎EE12例、Barrett食管10例）和9名健康志愿者行24小时食管pH检测和放大胃镜检查，于病变部取活检行H．pylori检测。结果内镜下，NERD组77．2％患者齿状线呈锯齿状、三角形及舌形与正常对照组比较差异有显著性（P＜0．01）；EE组83．3％患者食管下段粘膜血管呈螺旋型、不规则型炎症性表现与NERD组比较差异有显著性（P＜0．05）；Barreu组100％患者齿状线下黏膜小凹形态呈分枝状、斑片状或绒毛状，与EE组相比差异有显著性（确切概率法P=0．0396）。结论放大内镜下胃食管返流病特征性表现对于胃食管反流病的诊断有重要意义。     

Potential contribution of novel imaging modalities in non-erosive reflux disease

Non-erosive reflux disease (NERD) is the most frequent endoscopic finding in patients with gastro-oesophageal reflux disease (GORD). Conventional white light endoscopy is an insufficient tool for diagnosing subtle changes of the oesophageal mucosa in patients with NERD. This review will discuss the diagnostic approach and endoscopic features of novel endoscopic imaging techniques such as magnification endoscopy, chromoendoscopy, narrow band imaging (NBI) and confocal laser endomicroscopy (CLE) for patients with this disorder. Magnification endoscopy alone or in combination with chromoendoscopy offers the chance for an improved detection of subtle findings in NERD. However, subtle changes such as punctuate erythema above the Z-line, pinpoint vessels, triangular indentations and other findings show a substantial inter- and intra-observer variability with unacceptably low kappa values for justifying their use as a diagnostic criterion for NERD. NBI and endomicroscopy are fascinating new tools, but access to these novel modalities in clinical practice is limited and the area to be examined is small, which makes it very time-consuming to examine the entire distal oesophagus. It remains to be proven in crossover, randomised trials that these new imaging modalities may represent a significant improvement over standard endoscopy for the diagnosis of NERD.     

Narrow band imaging with magnification for the diagnosis of lesions in the upper gastrointestinal tract

Endoscopy plays an important role in the diagnosis and management of gastrointestinal(GI)tract disorders.Chromoendoscopy has proven to be superior to white light endoscopy for early detection of various GI lesions.This has however been fraught with problems.The use of color stains,time taken to achieve an effect and the learning curve associated with the technique has been some of the pitfalls.Narrow band imaging(NBI)particularly in combination with magnifying endoscopy may allow the endoscopist to accomplish a fairly accurate diagnosis with good histological correlation similar to results achieved with chromoendoscopy.Such enhanced detection of pre-malignant and early neoplastic lesions in the gastrointestinal tract should allow better targeting of biopsies and could ultimately prove to be cost effective.Various studies have been done demonstrating the utility of this novel technology.This article will review the impact of NBI in the diagnosis of upper gastrointestinal tract disorders.     

乌鲁木齐地区胃食管反流病患病状况调查

目的了解乌鲁木齐地区健康体检人群胃食管反流病（GERD）的患病率及可能相关的危险因素。 方法2017年4至6月在新疆维吾尔自治区人民医院体检中心连续就诊的5000名健康体检人群,应用Gerd Q量表诊断并进行问卷调查。 结果共收集调查5000名体检患者资料,本次调查共填写了5000例健康体检人群的调查问卷,其中4987例问卷填写清晰、完整。4987例调查者中,调查诊断出胃食管反流病患者887例,男性多于女性,维吾尔族GERD发生率显著高于汉族,体重指数（BMI）指数大于正常范围者GERD发生率高。心理压力大、生气、吸烟、经常饱食、排便困难、进食速度快、喜甜食、浓茶、肉类是GERD的危险因素。 结论本地区健康体检人群GERD患病率为17.79%。性别、民族、BMI、吸烟、心理压力大、生气、饮食习惯是乌鲁木齐地区GERD发病的主要危险因素。     

Image-enhanced endoscopy is specific for the diagnosis of non-erosive gastroesophageal reflux disease

Objectives: We assessed the performance characteristics of image-enhanced endoscopy with i-Scan or narrow band imaging (NBI) in patients with non-erosive gastroesophageal reflux disease (GERD) compared to controls without heartburn.

Material and methods: Image-enhanced endoscopic findings of vascularity at the squamocolumnar junction, distal esophageal micro-erosions, and non-round pit pattern at the squamocolumnar junction were assessed in cases (heartburn not responsive to PPIs, positive results on validated GERD questionnaire, no esophageal erosions, esophageal biopsies with histologic evidence of GERD (basal cell hyperplasia, elongation of papillae and dilation of intercellular spaces all required)) and in controls (no GERD symptoms or esophageal erosions).

Results: Twenty cases and 60 controls were compared. The pre-defined features were more common in cases vs. controls: vascularity RR?=?4.9 (95% CI: 2.4–10.0), specificity?=?86.7%; micro-erosions RR?=?9.7 (3.6–26.5), specificity?=?93.3%; non-round pit pattern RR?=?2.4 (1.7–3.3), specificity?=?60.0%; combination of vascularity and micro-erosions RR?=?30.0 (4.1–220), specificity?=?98.3%. These differences were consistent with both i-Scan and NBI.

Conclusions: Image-enhanced endoscopic findings of vascularity and micro-erosions were very specific for non-erosive GERD. Image-enhanced endoscopy may be useful in real-time diagnosis of non-erosive GERD when patients undergo upper endoscopy for heartburn. The relative utility of image-enhanced endoscopy vs. pH-impedance monitoring, based on efficacy, cost and patient acceptance, requires additional study.     

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.     

Evaluation of esophageal function in patients with gastroesophageal reflux disease using transnasal endoscopy

Background and Aims:  To investigate the utility of a new method of carrying out esophageal manometry using a narrow gauge manometry catheter via a transnasal endoscope.
Methods:  The Frequency Scale for the Symptoms of gastroesophageal reflux disease (GERD) (FSSG), a GERD-specific questionnaire, was given to 45 subjects. Subjects 
underwent transnasal endoscopy with three dry and three wet (3 mL water) swallows. Direct observations of the primary peristaltic wave and peristaltic pressure measurement were conducted simultaneously.
Results:  Endoscopic observation of lower esophageal motility associated with swallowing revealed dilatation of the esophageal lumen after swallowing, followed by contraction in association with the primary peristaltic wave. The peristaltic pressure was significantly lower with increased FSSG scores for dry swallows ( r  = −0.347, P  = 0.0212), but no significant correlation was seen for wet swallows.
Conclusions:  The significant negative correlation between reflux symptoms and peristaltic pressure in dry swallows was thought to be that reduced pressure immediately rostral to the lower esophageal sphincter leads to decreased clearance following gastric acid reflux, playing a large part in the onset of symptoms.