S, m, l, xl.
S, m, l, xl.
复制标题
S、米、l、xl。
DOI：
10.1136/gut.52.1.5
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发表时间：
2003
期刊：
影响因子：
24.5
通讯作者：
Triadafilopoulos,G
中科院分区：
文献类型：
--
作者：
Wang,T;Triadafilopoulos,G
GUT：首次发布为10.1136/GUT。52.1。5 2003年1月1日。从常规内窥镜的外观下载，与特发性肠化生的外观模糊。其次，异型增生在粘膜表面的分布可能有很大的差异--即局灶性、斑片状或弥漫性。因此，监测方法必须在大范围内敏感。第三，异型增生是一种组织病理学诊断，需要亚细胞图像分辨率才能显示核和核周形态。在实践中，通过常规成像方法，例如超声波、计算机断层扫描或磁共振成像，无法达到这种详细程度。到目前为止，最好的分辨率是通过光学方法获得的，但这些技术还没有达到体内的亚细胞分辨率。第四，在可能包含侵蚀、狭窄和炎症的食道环境中，经常需要检测异型增生。粘膜中的炎性变化可能会使对组织生物化学敏感的方法变得模糊，如荧光。第五，食道新鳞状上皮化可能发生在长时间的酸抑制或消融性损伤之后，因此监测方法必须能够识别新的(鳞状)粘膜表面下存在的Barrett化生。最后，出于实际目的，必须以时间和成本效益高的方式进行筛查。这套诊断要求相当严格，任何单一的监测技术都不太可能满足这一要求。此外，由于高度不典型增生的确诊可能会导致患者接受食道切除术，因此需要常规的活检进行确认。因此，迫切需要一种新的技术来指导活检，作为传统内窥镜的辅助手段。自从纤维内窥镜的早期以来，许多技术已经被用来识别特定的上皮细胞或增强粘膜表面特征。自1994年以来，放大率染色内窥镜单独或与亚甲蓝或靛红联合用于检测Barrett‘s食管肠化生，并描述了特征性的模式(绒毛、隆起)。Guelrud等人使用可调图像放大倍数在高达35×(M)的连续范围内，结合1.5%的醋酸滴注，描述了四种不同的粘膜表面模式，当注意到隆起模式时，对特殊肠化生的敏感度高达100%。5张使用或不使用亚甲蓝的高倍率图像(最大80倍，L)，使用装有透明帽的放大内窥镜，Endo等人根据组织学(胃或肠)表型对Barrett‘s上皮的浅表粘膜外观进行分类。6在本期《肠道》杂志中，7倍彩色内窥镜(115×，XL)是
Gut: first published as 10.1136/gut. 52.1. 5 on 1 January 2003. Downloaded from appearance on conventional endoscopy is indistinct from that of specialised intestinal metaplasia. Secondly, the distribution of dysplasia over the mucosal surface can be quite variable—that is, focal, patchy, or diffuse. Thus the method of surveillance must be sensitive over a wide area. Thirdly, dysplasia is a histopathological diagnosis that requires subcellular image resolution to visualise nuclear and perinuclear morphology. This level of detail cannot be achieved in practice by conventional imaging methods, such as ultrasound, computed tomography, or magnetic resonance imaging. The best resolution so far has been obtained by optical methods, but these techniques have yet to achieve subcellular resolution in vivo. Fourthly, detection of dysplasia is frequently needed in the setting of an oesophagus that may contain erosions, strictures, and inflammation. Inflammatory changes in the mucosa may obscure methods sensitive to tissue biochemistry such as fluorescence. Fifthly, neosquamous epithelialisation of the oesophagus can occur after prolonged acid suppression or ablative injury and thus methods of surveillance must be able to identify Barrett’s metaplasia present below the new (squamous) mucosal surface. Finally, for practical purposes, screening must be performed in a time and cost efficient manner. This set of diagnostic requirements is quite rigorous and is unlikely to be satisfied by any single technique of surveillance. Moreover, because the identification of high grade dysplasia may result in an oesophagectomy for the patient, a conventional biopsy is desired for confirmation. Thus a new technique that serves as a guide for biopsy as an adjunct to conventional endoscopy is greatly needed.Since the early days of fibreoptic endoscopy, many techniques have been used to identify specific epithelia or to enhance mucosal surface characteristics. Magnification chromoendoscopy alone or combined with methylene blue or indigo carmine has been used to detect intestinal metaplasia in Barrett’s oesophagus since 1994 and characteristic patterns (villous, ridged) have since been described. Using an adjustable image magnification in a continuous range up to 35×(M), combined with 1.5% acetic acid instillation, Guelrud et al described four different mucosal surface patterns and a sensitivity for specialised intestinal metaplasia of up to 100% when the ridged pattern was noted. 5 Highly magnified images (80× at maximum, L) with or without methylene blue using a magnifying endoscope fitted with a transparent cap allowed Endo et al to classify the superficial mucosal appearance of Barrett’s epithelium by histological(gastric or intestinal) phenotypes. 6 In this issue of Gut, 7 magnification chromoendoscopy (115×, XL) is