Enhanced magnification endoscopy: a new technique to identify specialized intestinal metaplasia in Barrett's esophagus
Enhanced magnification endoscopy: a new technique to identify specialized intestinal metaplasia in Barrett's esophagus
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DOI：
10.1067/mge.2001.114059
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发表时间：
2001-05-01
影响因子：
7.7
通讯作者：
Castro, J
中科院分区：
文献类型：
--
作者：
Guelrud, M;Herrera, I;Castro, J
背景：标准内窥镜检查无法识别巴雷特食管（BE）中的特殊肠化生（SIM）。醋酸滴注增强了检测鳞柱状结合处柱状上皮的能力。增强放大内窥镜检查涉及放大内窥镜检查与醋酸的联合使用。本研究评估了增强放大内镜检查在检测BE患者SIM中的价值。方法：因短节段BE而无不典型增生而接受内镜监测的患者接受1.5%乙酸滴注增强放大内镜检查，标准内镜检查后进行放大内镜检查，并在乙酸喷洒后重复检查。 Surface patterns were characterized prior to and after acetic acid spraying. The observed surface patterns were compared with histology results.Results: Forty-nine patients, 9 women and 39 men, with a mean age of 50.5 years were studied, One was excluded because of unclear definition of the surface pattern.增强放大内窥镜检测到4种不同的粘膜表面图案：I，圆凹坑； II、网状；三、绒毛状； IV，脊状。总共检查了 129 个区域。标准内窥镜检查在 1.5% 的区域中发现了内窥镜模式，标准内窥镜检查和乙酸在 8.5% 的区域中发现了内窥镜模式，仅放大内窥镜检查在 38% 中发现了内窥镜模式，而增强放大内窥镜检查在所有 129 个内窥镜区域中发现了内窥镜模式。根据内窥镜模式检测SIM的得率如下：模式I，0%； II，11%（比值比 0.5，p = 0.54）； III, 87% (odds ratio 36, p = 0.001); IV，100%（比值比 14，p = 0.015）。 结论：增强放大内窥镜检查是预测 BE 中 SIM 的准确方法。该技术简单，能够以出色的清晰度和分辨率识别特征性内窥镜模式，与特殊肠上皮化生的组织学鉴定相关，使增强放大内窥镜检查成为评估 BE 患者的绝佳方法。
Background: Specialized intestinal metaplasia (SIM) in Barrett's esophagus (BE) is not identifiable by standard endoscopy. Acetic acid instillation enhances the ability to detect columnar epithelium at the squamocolumnar union. Enhanced magnification endoscopy involves the combined use of magnification endoscopy with acetic acid. This study assessed the value of enhanced magnification endoscopy in detecting SIM in patients with BE.Methods: Patients undergoing endoscopic surveillance because of short segment BE without dysplasia underwent enhanced magnification endoscopy with 1.5% acetic acid instillation, Standard endoscopy was followed by magnification endoscopy and repeated after acetic acid spraying. Surface patterns were characterized prior to and after acetic acid spraying. The observed surface patterns were compared with histology results.Results: Forty-nine patients, 9 women and 39 men, with a mean age of 50.5 years were studied, One was excluded because of unclear definition of the surface pattern. Enhanced magnification endoscopy detected 4 different mucosal surface patterns: I, round pits; II, reticular; III, villous; and IV, ridged. A total of 129 areas were examined. Standard endoscopy identified an endoscopic pattern in 1.5% of the areas, standard endoscopy and acetic acid in 8.5%, magnification endoscopy alone in 38%, and enhanced magnification endoscopy in all 129 endoscopic areas. The yields for detecting SIM according to endoscopic patterns were as follows: pattern I, 0%; II, 11% (odds ratio 0.5, p = 0.54); III, 87% (odds ratio 36, p = 0.001); and IV, 100% (odds ratio 14, p = 0.015).Conclusions: Enhanced magnification endoscopy is an accurate method of predicting SIM in BE, The simplicity of the technique and its ability to identify characteristic endoscopic patterns with outstanding clarity and resolution that correlate with histologic identification of specialized intestinal metaplasia make enhanced magnification endoscopy an excellent method for the evaluation of patients with BE.