窄带成像放大内镜在胃黏膜肠上皮化生随访中的应用

背景：胃黏膜肠上皮化生的随访主要依赖随机活检,窄带成像放大内镜（NBI-ME）可能有助于提高肠上皮化生随访的准确性。目的：探讨NBI-ME在胃黏膜肠上皮化生随访中的应用价值。方法：选取2010年6月~2011年6月上海市第七人民医院120例萎缩性胃炎伴中-重度肠上皮化生随访复查胃镜患者,随机分成NBI-ME组和普通白光内镜（WLE）组,并行组织病理学检查,比较两组胃黏膜肠上皮化生的检出率。NBI-ME组内镜下观察浅蓝色嵴状结构（LBC）,并与组织病理学结果进行对比分析。结果：NBI-ME组56例患者检出胃黏膜肠上皮化生,WLE组为48例,NBI-ME组胃黏膜肠上皮化生的检出率显著高于WLE组（93.3%对80.0%,P〈0.05）;LBC诊断胃黏膜肠上皮化生的敏感性、特异性、阳性预测值和阴性预测值分别为89.4%、90.5%、93.3%和85.1%;NBI-ME下LBC阳性区域黏膜活检可明显提高肠上皮化生的检出率,差异有统计学意义（93.3%对14.9%,P〈0.05）。结论：在胃黏膜肠上皮化生随访中,NBI-ME下LBC阳性区域黏膜活检有助于提高肠上皮化生的检出率。

Application of Narrow Band Imaging-magnifying Endoscopy in Surveillance of Gastric Mucosal Intestinal Metaplasia

Background: Surveillance of gastric mucosal intestinal metaplasia relies mainly on random biopsy sampling.Narrow band imaging-magnifying endoscopy(NBI-ME) may enhance the accuracy of endoscopic surveillance of intestinal metaplasia.Aims: To assess the clinical value of NBI-ME in the surveillance of gastric mucosal intestinal metaplasia.Methods: One hundred and twenty cases of atrophic gastritis with moderate to severe intestinal metaplasia from June 2010 to June 2011 at Shanghai 7th People’s Hospital were enrolled,and were randomly divided into NBI-ME group and normal white light endoscopy(WLE) group.Biopsy specimens were obtained for histopathological examination and the detection rate of gastric mucosal intestinal metaplasia in the two groups was compared.Light blue crest(LBC) observed under NBI-ME was compared with the histopathological result.Results: Gastric mucosal intestinal metaplasia was diagnosed in 56 patients by NBI-ME,while in 48 patients by WLE.The detection rate of gastric mucosal intestinal metaplasia in NBI-ME group was significantly higher than that in WLE group(93.3% vs.80.0%,P<0.05).The sensitivity,specificity,positive predictive value and negative predictive value of LBC in diagnosis of gastric mucosal intestinal metaplasia were 89.4%,90.5%,93.3%,85.1%,respectively.Targeted biopsy from LBC region under NBI-ME increased significantly the detection rate of gastric mucosal intestinal metaplasia(93.3% vs.14.9%,P<0.05).Conclusions: In surveillance of gastric mucosal intestinal metaplasia,targeted biopsy from LBC region under NBI-ME may increase the detection rate of intestinal metaplasia.