窄带成像放大内镜在胃黏膜萎缩和肠化生诊断中的应用价值
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摘要
探讨窄带成像放大内镜(NBI-ME)在萎缩性胃炎、肠上皮化生诊断中的应用价值,并观察胃黏膜萎缩、肠化生与胃小凹形态改变的关系。连续纳入内镜检查患者384例,随机分为白光组和NBI-ME组,比较两组内镜诊断结果与组织学诊断结果的一致性,并按照胃小凹Sakaki分型,分析萎缩、肠化生与黏膜微细结构的关系。以组织学诊断为金标准,NBI-ME诊断萎缩的一致性明显高于白光内镜(Kappa值87. 16%vs 50. 49%);NBI-ME诊断肠化生的一致性亦明显高于白光内镜(Kappa值91. 88%vs 59. 04%)。在NBI-ME内镜图像Sakaki分型中Ⅱ、Ⅲ型可用于萎缩的诊断;Ⅳ、Ⅴ型可用于肠化生的诊断。与白光内镜检查结果比较,NBI-ME对萎缩、肠化生的诊断效能较高。NBI-ME下胃小凹形态分型有助于区分胃黏膜萎缩和肠化生的内镜征象。
To investigate the value of narrow-band imaging magnifying endoscopy( NBI-ME) in the diagnosis of atrophic gastritis and intestinal metaplasia,and to observe the relationship between atrophy,intestinal metaplasia and morphologic changes of gastric pits. 384 patients undergoing endoscopic examination were consecutive enrolled and randomly divided into white light group and NBI-ME group. The consistency of endoscopic diagnosis and histological diagnosis between the two groups were compared,and the relationship between atrophy,intestinal metaplasia and microstructure of mucous membrane were analyzed according to the Sakaki typing of gastric pits. With histological diagnosis as the gold standard,the consistency of NBI-ME in diagnosis of atrophy was significantly higher than that of white light endoscopy( Kappa value 87. 16% vs 50. 49%); the consistency of NBI-ME in the diagnosis of intestinal metaplasia was also significantly higher than that of white light endoscopy( Kappa value 91. 88% vs59. 04%). In the Sakaki typing of NBI-ME endoscopic images,type Ⅱ and Ⅲ can be used for the diagnosis of atrophy; type Ⅳ and Ⅴ can be used for the diagnosis of intestinal metaplasia. Compared with the results of the white endoscopy,NBI-ME has a higher diagnostic efficiency for atrophy and intestinal metaplasia. The morphological classification of gastric pits under NBI-ME helps to distinguish endoscopic signs of atrophy of gastric mucosa and intestinal metaplasia.
To investigate the value of narrow-band imaging magnifying endoscopy( NBI-ME) in the diagnosis of atrophic gastritis and intestinal metaplasia,and to observe the relationship between atrophy,intestinal metaplasia and morphologic changes of gastric pits. 384 patients undergoing endoscopic examination were consecutive enrolled and randomly divided into white light group and NBI-ME group. The consistency of endoscopic diagnosis and histological diagnosis between the two groups were compared,and the relationship between atrophy,intestinal metaplasia and microstructure of mucous membrane were analyzed according to the Sakaki typing of gastric pits. With histological diagnosis as the gold standard,the consistency of NBI-ME in diagnosis of atrophy was significantly higher than that of white light endoscopy( Kappa value 87. 16% vs 50. 49%); the consistency of NBI-ME in the diagnosis of intestinal metaplasia was also significantly higher than that of white light endoscopy( Kappa value 91. 88% vs59. 04%). In the Sakaki typing of NBI-ME endoscopic images,type Ⅱ and Ⅲ can be used for the diagnosis of atrophy; type Ⅳ and Ⅴ can be used for the diagnosis of intestinal metaplasia. Compared with the results of the white endoscopy,NBI-ME has a higher diagnostic efficiency for atrophy and intestinal metaplasia. The morphological classification of gastric pits under NBI-ME helps to distinguish endoscopic signs of atrophy of gastric mucosa and intestinal metaplasia.
引文
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[11] Simko V,Anand N,Ginter E. Gastric intestinal meteplasia-age,ethnicity and surveillance for gastric cancer[J]. Bratisl Lek Listy,2015,116(1):3-8.
[12] Serrano M,Kikuste I,Dinis-Ribeiro M. Advanced endoscopic imaging for gastric cancer assessment:new insights with new optics?[J]. Best Pract Res Clin Gastroenterol,2014,28(6):1079-91.
[13]唐琳.窄带成像联合放大内镜诊断慢性萎缩性胃炎及肠上皮化生的临床研究[D].南昌:南昌大学,2016.
[14] Bansal A,Ulusarac O,Mathur S. Correlotion between narrow-band imaging and nonneoplastic gastric patholopy:a pilot feasibility trial[J]. Gastrointestinal Endoscopy,2008,67(2):210-6.
[15] Tongtawee T,Kaewpitoon S,Kaewpitoon N,et al. Correlation between gastric mucosal morphologic patterns and histopathological severity of Helicobacter pylori associated gastritis using conventional narrow band imaging gastroscopy[J]. Biomed Research Internation,2015,2015:808505.
[2] Dutta A K,Sajith K G,Pulimood A B,et al. Narrow band imaging versus white light gastroscopy in detecting potentially premalignant gastric lesions:a randomized prospective crossover study[J]. Indian J Gastroenterol,2013,32(1):37-42.
[3] Tahara T,Shibata T,Nakamura M,et al. Gastric mucosal pattern by using magnifying narrow-band imaging endoscopy clearly distinguishes histological and serological severity of chronic gastritis[J].Gastrointestinal Endoscopy,2009,70(2):246-53.
[4] Tahara T,Tahara S,Tuskamoto T,et al. Magnifying NBI patterns of gastric mucosa after Helicobacter pylori eradication and its potential link to the gastric cancer risk[J]. Digestive Diseases&Science,2017,62(9):2421-7.
[5] Yamasaki Y,Uedo N,Kanzaki H,et al. Investigation of mucosal pattern of gastric antrum using magnifying narrow-band imaging in patients with chronic atrophic fundic gastritis[J]. Annals of Gastroenterology,2017,30(3):302-8.
[6]房静远,刘文忠,李兆申,等.中国慢性胃炎共识意见[J].胃肠病学,2013,18(1):24-6.
[7]苏振华,魏思忱,王亮,等.窄带成像放大内镜诊断慢性萎缩性胃炎的价值[J].胃肠病学,2015,20(11):676-9.
[8]汤瑜,向培,张鑫,等.窄带成像结合放大内镜在慢性萎缩性胃炎诊断中的应用[J].江苏医药,2013,39(18):2189-90.
[9] Takao K,Kenshi Y,Takashi N,et al. Extending magnifying NBI diagnosis of intestinal metaplasia in the stomach:the white opaque substance marker[J]. Endoscopy,2017,49(6):529-35.
[10] Sakaki N,Iida Y,Okazaki Y,et al. Magnifying endoscopic observation of the gastric mucosa,particularly in patients with atrophic gastritis[J]. Endoscopy,1978,10(4):269-74.
[11] Simko V,Anand N,Ginter E. Gastric intestinal meteplasia-age,ethnicity and surveillance for gastric cancer[J]. Bratisl Lek Listy,2015,116(1):3-8.
[12] Serrano M,Kikuste I,Dinis-Ribeiro M. Advanced endoscopic imaging for gastric cancer assessment:new insights with new optics?[J]. Best Pract Res Clin Gastroenterol,2014,28(6):1079-91.
[13]唐琳.窄带成像联合放大内镜诊断慢性萎缩性胃炎及肠上皮化生的临床研究[D].南昌:南昌大学,2016.
[14] Bansal A,Ulusarac O,Mathur S. Correlotion between narrow-band imaging and nonneoplastic gastric patholopy:a pilot feasibility trial[J]. Gastrointestinal Endoscopy,2008,67(2):210-6.
[15] Tongtawee T,Kaewpitoon S,Kaewpitoon N,et al. Correlation between gastric mucosal morphologic patterns and histopathological severity of Helicobacter pylori associated gastritis using conventional narrow band imaging gastroscopy[J]. Biomed Research Internation,2015,2015:808505.