Progression of a sessile serrated adenoma to an early invasive cancer within 8 months

Recent studies suggest that serrated polyps, including hyperplastic polyps, traditional serrated adenomas, and sessile serrated adenomas, may be morphologically and genetically distinct and linked to microsatellite unstable colorectal cancers, and thus the concept of a hyperplastic polyp–serrate adenoma–carcinoma pathway has been suggested. Furthermore, it has been suggested that transformation from serrated polyps to invasive cancers can be rapid and occurs when the lesions are small; however, direct evidence for this issue is scant. We herein describe a case of a sessile serrated adenoma showing rapid transformation into a submucosal invasive carcinoma with remarkable morphological change in a short period of 8 months. This case is unique and suggestive, as it provided information about the natural history of a sessile serrated adenoma.     

High technology imaging in digestive endoscopy

A thorough endoscopic visualization of the digestive mucosa is essential for reaching an accurate diagnosis and to treat the different lesions. Standard white light endoscopes permit a good mucosa examination but, nowadays, the introduction of powerful endoscopic instrumentations increased ability to analyze the fi nest details. By applying dyes and zoom-magnifi cation endoscopy further architectural detail of the mucosa can be elucidated. New computed virtual chromoendoscopy have further enhanced optical capabilities for the evaluation of submucosal vascolar pattern. Recently, confocal endomicroscopy and endocytoscopy were proposed for the study of ultrastructural mucosa details. Because of the technological contents of powerful instrumentation, a good knowledge of implemented technologies is mandatory for the endoscopist, nowadays. Nevertheless, there is a big confusion about this topic. We will try to explain these technologies and to clarify this terminology.     

FICE 不同波长组合加放大内镜观察大肠隆起性病变微细结构的应用研究

目的：探讨应用FICE波长最佳组合＋放大内镜观察大肠隆起性病变微细结构,与病变病理学诊断结果相对照,对大肠隆起性病变作出正确及时的诊断并加以治疗。方法：用放大变焦结肠镜常规检查,记录病灶部位,形态。用FICE的10种红绿蓝（ RGB ）不同波长组合,观察粘膜表面的微细腺管形态及微血管形态,记录最佳波长组合,然后使用放大40-200倍放大病灶。结果：通过应用FICE不同波长最佳组合＋放大内镜观察结肠隆起性病变的微细结构,与病理组织学诊断符合率在90％以上。结论：根据FICE不同波长最佳组合＋放大内镜观察可即时鉴别结肠粘膜的肿瘤性及非肿瘤性病变,指导相应的镜下或手术治疗,提高诊治早期大肠癌的敏感性和准确率。     

微焦点高千伏放大摄影应用价值的研究

作者对２３１例常规Ｘ线摄影难以确诊的病例行微焦点高干伏放大摄影（摄影焦点０．３ｍｍ、放大率２倍），并作对照研究。其中胸部１５２例，骨骼７９例；共３１１个部位，２６种病变。研究结果表明，本法在显示病变的微细结构方面明显优于常规片。该方法集微焦点、高千伏和放大摄影的技术优势于一体，可显著提高成像质量，提高人体生理视阈和肉眼的能见度，为Ｘ线诊断提供敏感而可靠的病理改变信息。并可减少病人的照射量，延长Ｘ线     

放大内镜下氩离子凝固术对Barrett食管诊治研究

目的评价色素放大内镜结合氩离子凝固术(APC)对Barrett食管(BE)诊断及治疗效果。方法对26例经病理确诊BE病例观察其放大内镜特点并行氩离子凝固治疗,于术后3个月、半年及1年复查,观察近期疗效。结果所有患者均完成APC治疗,无并发症出现,共随访1年其中5例再次发现柱状上皮。结论放大内镜结合APC治疗Barrett食管安全、有效易行,但有一定比例复发,须定期复查。     

大肠粘膜腺管开口对粘膜病变的诊断价值

目的：探讨放大内镜结合腺管开口分型在诊断大肠粘膜病变性质的临床应用价值。方法：放大内镜检查中，发现病变后，对病灶喷洒靓胭脂，采用放大内镜观察病灶粘膜腺管开口形态，按Kudo分型作病灶性质判断 ，并与切除或活检组织作病理学比较。结果：在194处病灶中，放大内镜诊断为炎性息肉、管状腺瘤、绒毛状腺瘤和大肠癌的病理符合率分别为100.0％、93.3％、90.9％、100.0％，总病理符合率为96.1％。结论：放大内镜对判断大肠病变性质有较高的病理符合率，使我们能够区分肿瘤与非肿瘤，良性与恶性肿瘤，预测癌的浸润深度，决定合适的治疗方式，具有较高的临床应用价值。     

结直肠肿瘤样病变内镜活检与黏膜切除术后病理诊断比较

背景：结直肠肿瘤样病变内镜黏膜切除术（EMR）后病理诊断与术前内镜活检病理诊断的差异未明。目的：评估放大色素内镜指导下EMR获得的结直肠肿瘤样病变标本的诊断价值。方法：连续收集接受EMR治疗的直径≤2cm的无蒂型或平坦、凹陷型结直肠肿瘤样病变纳入研究,分析EMR病理诊断与术前活检病理诊断的差异。结果：共纳入EMR切除病灶90个,无蒂型25个,平坦、凹陷型65个,后者为高度异型增生（HGD）或腺癌的可能性略高于前者（41．5％对20．0％,P〉0．05）。术前活检病理诊断的总体准确性为68．9％,28个（31．1％）病灶的诊断于术后发生改变．其中4个增生性病变术后均诊断为低度异型增生（LGD）,14个LGD诊断为HGD,5个LGD诊断为腺癌,5个HGD诊断为腺癌。病灶形态学表现及其浸润深度与病理诊断结果的改变无关。结论：放大色素内镜指导下的EMR病理诊断纠正了本组近1／3结直肠肿瘤样病变的术前活检病理诊断,具有完善诊断和治疗的双重作用。     

窄带成像放大内镜诊断早期食管癌的临床价值研究

目的 探讨窄带成像放大内镜(NBI-ME)诊断早期食管癌的临床价值.方法 选取2018年1月至2021年1月间上海市金山区亭林医院收治的经病理证实的200例高级别上皮内瘤变或早期食管癌患者,采用随机数表法分为普通内镜组、超声内镜组、NBI-ME组和窄带成像(NBI)-碘染色内镜组,每组50例.普通内镜组患者采用普通内镜...