染色内镜和放大内镜诊治大肠侧向发育型肿瘤

目的大肠侧向发育型肿瘤(LST)与大肠癌关系密切,其诊治不同于一般的隆起样肿瘤,文章总结LST内镜诊断与治疗的经验,以引起临床上对这个特殊类型肿瘤的重视。方法内镜检查发现肠道黏膜发红或粗糙、血管网不清或消失等病变,行靛胭脂染色后放大内镜观察其腺管开口类型。结果18个月中共发现34例LST 35个病变。其中黏膜内癌4例,锯齿状肿瘤2例。35个病变内镜分型颗粒均一型15个,结节混合型18个,假凹陷型2个。病变最大为68 mm×85 mm;11～20mm 8个,21～30 mm 13个,30 mm以上14个。大肠黏膜腺管开口类型ⅢL型10个,其中8个为管状绒毛状腺瘤;Ⅳ型22个,其中16个为绒毛状腺瘤,1个黏膜内癌;ⅤA型3个,均为黏膜内癌。35个病变全部即时或择期进行内镜下切除治疗,发生出血和局限性腹膜炎各1例。结论应用黏膜染色技术和放大内镜有助于LST的诊断。LST的腺管开口大多数表现为Ⅳ型或ⅢL型,ⅢL型腺管开口多为管状腺瘤,Ⅳ型腺管开口多为绒毛状腺瘤,一旦出现Ⅴ型腺管开口则表明已经有癌变发生。     

Usefulness of magnifying endoscopy for iodine-unstained lesions in a high-risk esophageal cancer population

AIM: To investigate the usefulness of magnified observations of iodine-unstained esophageal lesions in the histological diagnosis of esophageal mucosa abnormalities, in high-risk esophageal cancer groups. METHODS: The subjects included 38 patients who had at least one of the four criteria known to be highrisk factors for esophageal cancer. Following endoscopic observation, magnified observations were performed on iodine-unstained lesions of the esophagus. The total number of lesions was 43. These lesions we...     

智能电子分光技术在判断幽门螺杆菌感染胃黏膜病变中的研究

目的通过智能电子分光技术（FICE）结合高分辨率放大内镜,描述正常及胃黏膜病变的特征性改变,并探讨其与幽门螺杆菌（H.pylori）及组织病理学的相关性。方法选择32例消化不良患者及5例正常志愿者,在内镜检查中分别于胃窦及胃体部行放大内镜及FICE观察,对胃黏膜按胃小凹形态做出相应分型（Ⅰ～Ⅲ型）,并行快速尿素酶^13C-尿素呼气试验及组织病理学检查。分析胃窦及胃体FICE下的分型对诊断H.pylori的价值,并对FICE观察部位的组织病理学改变（活动性、炎症度、萎缩、肠化）进行分级评估。结果对照组5例胃窦及胃体黏膜的FICE分型均为Ⅰ型,提示无H.pylori感染。研究组32例中,胃窦黏膜FICE分型为Ⅰ型14例,其中1例H.pylori感染（7．1％）;Ⅱ型13例中10例H.pylori感染（76．9％）,且9例同时有萎缩改变;Ⅲ型5例,均H.pylori感染,且3例同时有萎缩及肠化。胃窦黏膜各FICE分型间H.pylori感染情况的差异具有统计学意义（P〈0．01）;Ⅲ型结构与组织病理学诊断的一致性较好（kappa=0．890）。胃体黏膜FICE分型为Ⅰ型15例,其中1例H.pylori感染（6．7％）;Ⅱ型13例中11例（84．6％）H.pylori感染;Ⅲ型4例均存在H.pylori感染。胃体黏膜各FICE分型间H.pylori感染情况的差异具有统计学意义（P〈0．01）。组织病理学改变（炎症性、活动度、萎缩及肠化）的分级在无H.pylori感染组中显著低于H．pylori感染组（P〈0．01）。结论H.pylori感染与胃黏膜的炎症程度及萎缩、肠化生有明显相关性;FICE技术结合高分辨率放大内镜对预测H.pylori的存在及判断胃黏膜的病变具有一定临床价值。     

Validation of Fujinon intelligent chromoendoscopy with high definition endoscopes in colonoscopy

AIM: To validate high definition endoscopes with Fujinon intelligent chromoendoscopy (FICE) in colonoscopy.METHODS: The image quality of normal white light endoscopy (WLE), that of the 10 available FICE filters and that of a gold standard (0.2% indigo carmine dye) were compared.RESULTS: FICE-filter 4 [red, green, and blue (RGB) wavelengths of 520, 500, and 405 nm, respectively] provided the best images for evaluating the vascular pattern compared to white light. The mucosal surface was best assessed using filter 4. However, the views obtained were not rated significantly better than those observed with white light. The “gold standard”, indigo carmine (IC) dye, was found to be superior to both white light and filter 4. Filter 6 (RGB wavelengths of 580, 520, and 460 nm, respectively) allowed for exploration of the IC-stained mucosa. When assessing mucosal polyps, both FICE with magnification, and magnification following dye spraying were superior to the same techniques without magnification and to white light imaging. In the presence of suboptimal bowel preparation, observation with the FICE mode was possible, and endoscopists considered it to be superior to observation with white light.CONCLUSION: FICE-filter 4 with magnification improves the image quality of the colonic vascular patterns obtained with WLE.     

放大内镜下胃溃疡小凹分类及临床意义

目的探讨放大内镜下胃良、恶性溃疡小凹形态改变及其临床意义。方法应用Olympus GF-H260Z型电子放大内镜对67例胃溃疡病变患者进行观察。利用其放大功能观察溃疡周围胃小凹形态改变，并指导内镜下病理组织学的取材。结果67例病变中55例为良性溃疡，12例为恶性溃疡，周边小凹开口呈F型，其中3例为重叠E型改变。结论胃溃疡周边小凹形态改变与病灶的良、恶性存在密切关系。     

肠镜下黏膜平坦型病变的临床意义

目的应用放大内镜结合黏膜染色技术寻找平坦型病变,比较大肠黏膜隆起型病变与平坦型病变肿瘤情况。方法16457例患者通过放大结肠镜检查来寻找大肠隆起型与平坦型病变。记录患者年龄、性别等资料,对大肠隆起型和平坦型腺瘤性息肉的发生率、内镜下表现、病理类型进行分析。结果（1）共检出腺瘤和癌变2218例,平坦型170例（7．67％）。（2）隆起型肿瘤平均直径为（29±9）mm,平坦型肿瘤平均直径为（17±14）mm。（3）隆起型和平坦型肿瘤发生在左侧结肠分别为1630例（79．59％）和140例（82．35％）。（4）隆起型和平坦型肿瘤性病变中发生管状腺瘤,绒毛状腺瘤和混合状腺瘤的例数分别为1051例（51．34％）和95例（55．55％）,87例（4．25％）和29例（19．96％）,180例（8．79％）和30例（17．54％）。（5）隆起型和平坦型腺瘤中轻度不典型增生,中度不典型增生,重度不典型增生和早期癌变例数分别为638例（31．15％）和44例（25．88％）,337例（16．46％）和34例（20．00％）,45例（2．20％）和16例（9．41％）。结论重度不典型增生和早期癌变率的发现率平坦型病变明显高于隆起型病变。大肠黏膜腺瘤平坦型病变与隆起型病变相比,恶性程度更高。     

放大肠镜与染色技术在诊治早期结肠肿瘤中的应用

目的研究大肠息肉大小、表面结构形态和病理组织学关系,提高对大肠癌早期病变的检出率及实时诊治水平。方法对60例85枚大肠息肉用0.4%靛胭脂染色,放大内镜观察其腺管开口形态,在根据工藤法基础上增加了混合型,Ⅰ、Ⅱ型为非瘤性息肉,ⅢL、ⅢS、Ⅳ及混合型为腺瘤性息肉,ⅤI、ⅤN型为癌变,比较息肉腺管开口形态与息肉形态、大小和病理之间的关系。结果带蒂息肉多为Ⅰ、Ⅱ型(11/14),ⅢL、ⅢS、Ⅳ、ⅤI、ⅤN及混合型主要为亚蒂和广基息肉(49/71),ⅤI、ⅤN型均伴有糜烂、溃疡和质地脆;小于1.0cm息肉多见于Ⅰ、Ⅱ型(28/37),Ⅲ、Ⅳ、Ⅴ及混合型多大于1.0cm(45/52);炎性、增生及幼年性息肉中非瘤性形态分型85.7%,瘤性形态分型14.3%;腺瘤中非瘤性形态分型6.1%,瘤性形态分型93.9%。分型判断瘤性和非瘤性息肉的敏感性为92.2%和85.3%,特异性为87.9%和90.4%,其诊断准确性为90.2%。结论放大内镜结合黏膜染色分析大肠息肉腺管开口形态,能有效鉴别大肠非瘤性息肉、腺瘤和癌,在检查过程中实时地有效地选择性处理大肠息肉。     

Magnifying narrow-band imaging endoscopy is superior in diagnosis of early gastric cancer

AIM: To evaluate the diagnostic effectiveness of white light endoscopy, magnifying endoscopy (ME), and magnifying narrow-band imaging endoscopy (ME-NBI) in detecting early gastric cancer (EGC).METHODS: From March 2010 to June 2012, a total of 3616 patients received screening for gastric cancer by magnifying endoscopy. There were 3675 focal gastric lesions detected using conventional high definition white light endoscopy (HD-WLE) in four different referential hospitals that were recruited for further investigation using ME and ME-NBI. The images obtained from HD-WLE, ME, and ME-NBI were reviewed by four experienced endoscopists to evaluate their diagnostic effectiveness for EGC. The diagnosis of cancerous and non-cancerous lesions was conducted by evaluating the microvascular and microsurface patterns using the VS classification system. The final endoscopic diagnosis of each lesion was determined by consultation when a disagreement occurred. We used histopathological results as the gold standard for the diagnosis of EGC.RESULTS: Among the 3675 lesions found, 1508 were validated by pathological findings as chronic gastritis, 1279 as chronic gastritis with intestinal metaplasia, 631 as low-grade neoplasia, and 257 as EGC. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of HD-WLE for the diagnosis of EGC were 71.2%, 99.1%, 85.5%, 97.9% and 97.1%, respectively. The results of ME for diagnosing EGC were 81.3%, 98.8%, 83.3%, 98.6% and 97.6%, respectively. The results of ME-NBI for the diagnosis of EGC were 87.2%, 98.6%, 82.1%, 99.0% and 97.8%, respectively. The diagnostic sensitivity and accuracy of paired ME and ME-NBI were significantly better than those of HD-WLE (P < 0.05).CONCLUSION: HD-WLE has a relatively high accuracy for diagnosing EGC and is an effective screening tool. Further investigations of ME and ME-NBI are required to achieve superior accuracy.     

Magnifying endoscopy of gastric epithelial dysplasia based on the morphologic characteristics

AIM: To investigate the difference in magnifying endoscopic findings of gastric epithelial dysplasias (GEDs) according to the morphologic characteristics.METHODS: This study included 46 GED lesions in 45 patients who underwent magnifying endoscopy using narrow band imaging (ME-NBI) before endoscopic resection. During ME-NBI, the microvascular and microsurface (MS) patterns and the presence of light blue crest (LBC) and white opaque substance were investigated. GEDs were categorized as adenomatous, foveolar, and hybrid types, and their mucin phenotype was evaluated.RESULTS: Of the 46 lesions, 27 (59%) were categorized as adenomatous, 15 (32%) as hybrid, and the remaining 4 (9%) as foveolar. All adenomatous GEDs showed the round pit and/or tubular MS patterns, all foveolar GEDs showed the papillary pattern, and hybrid GEDs showed mixed patterns (P < 0.001). LBC was more frequently observed in adenomatous GEDs than in hybrid or foveolar GEDs (52%, 33%, 0%, respectively), although this difference was not significant (P = 0.127). The papillary MS pattern was associated with MUC5AC and MUC6 expression, and the round pit and/or tubular MS patterns were associated with CD10 expression.CONCLUSION: The MS pattern in ME-NBI findings is useful for predicting the morphologic category and mucin phenotype of GEDs, and ME-NBI findings may guide decisions regarding GED treatment.