Magnification chromoendoscopy for the detection of intestinal metaplasia and dysplasia in Barrett's oesophagus
Magnification chromoendoscopy for the detection of intestinal metaplasia and dysplasia in Barrett's oesophagus
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DOI：
10.1136/gut.52.1.24
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发表时间：
2003-01-01
期刊：
影响因子：
24.5
通讯作者：
Sampliner, RE
中科院分区：
文献类型：
--
作者：
Sharma, P;Weston, AP;Sampliner, RE
背景：在柱状排列的远端食道中存在肠化生(IM)，这定义了Barrett‘s食道具有未来恶变的风险。在柱状排列的食道内，IM和异型增生(低级别(LGD)和高级别(HGD))的分布是斑片状和马赛克的，需要随机活检。目的：研究高倍率染色内窥镜(MCE)在Barrett‘s食管炎、LGD和HGD诊断中的应用。方法：使用奥林巴斯放大内窥镜(GIF-Q16OZ，115x)对连续发现的食管远端柱状黏膜病变患者进行研究。在高倍镜下，对远端食道喷洒靛红溶液，观察到食管柱状粘膜形态，并进行活检。结果：80例疑似Barrett‘s食管者，年龄35~81岁，平均62.7岁。柱状黏膜长度0.5~17 cm，平均3.7 cm。喷洒靛红和MCE后，柱状粘膜内可见三种类型的粘膜模式：脊状/绒毛型、环状和不规则/扭曲型。靶区活检IM的切除率为：隆起/绒毛57/62(97%)，环状2/12(17%)。6例均为不规则/扭曲形态，活检均有HGD(6/6(100%))。18例患者在目标活检上有LGD，均为脊状/绒毛型。所有长节段Barrett‘s患者均可通过MCE识别，而短节段Barrett’s患者中有23例(82%)有脊状/绒毛图案。结论：MCE有助于直观地识别具有特定模式的IM和HGD区域，而不是LGD患者(看起来类似IM)。MCE可能是一种有用的临床工具，可用于增加IM患者的检测以及监测患者的HGD。如果这些初步结果得到验证，MCE将有助于确定高产地区，有可能消除随机活组织检查的需要。
Background: The presence of intestinal metaplasia (IM) in the columnar lined distal oesophagus defines Barrett's oesophagus with the risk of future malignant transformation. The distribution of both IM and dysplasia (low grade (LGD) and high grade (HGD)) within the columnar lined oesophagus is patchy and mosaic requiring random biopsies. Techniques that could help target areas of high yield within Barrett's mucosa would be helpful.Aim: To study the utility of high magnification chromoendoscopy (MCE) in the detection of IM, LGD, and HGD in patients with Barrett's oesophagus.Methods: Consecutive patients detected with columnar mucosa in the distal oesophagus were studied using an Olympus magnification endoscope (GIF-Q16OZ, 115x). The distal oesophagus was sprayed with indigo carmine solution and the oesophageal columnar mucosa patterns were noted under high magnification and targeted for biopsy. All biopsies were read by pathologists blinded to the endoscopic findings.Results: Eighty patients with suspected Barrett's oesophagus (that is, columnar lined distal oesophagus) were studied: mean age 62.7 years (range 35-81). Mean length of columnar mucosa was 3.7 cm (range 0.5-17). Three types of mucosal patterns were noted within the columnar mucosa after spraying indigo carmine and using MCE: ridged/villous pattern, circular pattern, and irregular/distorted pattern. The yield of IM on target biopsies according to the patterns was: ridged/villous 57/62 (97%) and circular 2/12 (17%). Six patients had an irregular/distorted pattern and all had HGD on biopsy (6/6 (100%)). Eighteen patients had LGD on target biopsies; all had the ridged/villous pattern. All patients with long segment Barrett's were identified using MCE whereas 23/28 patients (82%) with short segment Barrett's had the ridged/villous pattern.Conclusions: MCE helps visually identify areas with IM and HGD having specific patterns but not patients with LGD (appear similar to IM). MCE may be a useful clinical tool for the increased detection of patients with IM as well as for surveillance of patients for the detection of HGD. If these preliminary results are validated, MCE would help identify high yield areas, potentially eliminating the need for random biopsies.