Kiesslich R, von Bergh M, Hahn M, Hermann G, Jung M
I Med. Klinik und Poliklinik, Johannes-Gutenberg-Universität, Mainz, Germany.
Endoscopy. 2001 Dec;33(12):1001-6. doi: 10.1055/s-2001-18932.
Depressed early cancers and flat adenomas have a high potential for malignancy with possible infiltrating growth, despite the small size of the lesion. Japanese investigators have shown that early diagnosis and classification of these lesions is possible with the help of chromoendoscopy. The aim of this study, therefore, was to evaluate the usefulness of chromoendoscopy during routine colonoscopy.
During routine colonoscopy, vital staining with indigocarmine solution (0.4 %, 1 - 10 ml) was performed on all visible lesions in 100 consecutive patients without visible inflammatory changes. If findings on macroscopic examination were unremarkable, the sigmoid colon and rectum were stained with indigocarmine over a defined segment (0 - 30 cm ab ano) and inspected for lesions visible only after staining. Each lesion was classified with regard to type (polypoid, flat, or depressed), position and size. The staining pattern was classified according to the pit pattern classification.
A total of 52 patients had 105 visible lesions (89 polypoid, 14 flat and two depressed). The mean size of the lesions was 1.4 cm. Among the 48 patients with mucosa of normal appearance, 27 showed 178 lesions after staining (176 flat, two depressed) with a mean size of 3 mm. On histological investigation, 210 lesions showed hyperplastic or inflammatory changes, 67 were adenomas and six were cancers. Use of the pit pattern system to classify lesions (adenomatous, pit patterns III-V; nonadenomatous, pit patterns I-II) was possible, with a sensitivity of 92 % and a specificity of 93 %. Lesions with pit patterns III - V showed higher rates of dysplasia.
Chromoendoscopy allows easy detection of mucosal lesions in the colon and facilitates visualization of the margins of flat lesions. This technique unmasks multiple mucosal lesions which are not identified by routine video colonoscopy. The pit pattern seen after staining allows differentiation between hyperplastic and adenomatous lesions which may have consequences with regard to the endoscopic interventions needed.
早期凹陷性癌和平坦腺瘤尽管病变较小，但具有较高的恶性潜能，可能呈浸润性生长。日本研究人员表明，借助染色内镜检查可实现对这些病变的早期诊断和分类。因此，本研究的目的是评估染色内镜检查在常规结肠镜检查中的实用性。
在常规结肠镜检查期间，对100例连续的无明显炎症改变的患者的所有可见病变进行靛胭脂溶液（0.4%，1 - 10毫升）活体染色。如果肉眼检查结果不明显，则对乙状结肠和直肠在规定节段（距肛门0 - 30厘米）进行靛胭脂染色，并检查仅在染色后可见的病变。根据病变类型（息肉样、平坦或凹陷）、位置和大小对每个病变进行分类。染色模式根据凹窝模式分类法进行分类。
共有52例患者有105个可见病变（89个息肉样、14个平坦和2个凹陷）。病变的平均大小为1.4厘米。在48例外观正常的黏膜患者中，27例在染色后出现178个病变（176个平坦、2个凹陷），平均大小为3毫米。组织学检查显示，210个病变表现为增生性或炎症性改变，67个为腺瘤，6个为癌。使用凹窝模式系统对病变进行分类（腺瘤性，凹窝模式III - V；非腺瘤性，凹窝模式I - II）是可行的，敏感性为92%，特异性为93%。凹窝模式III - V的病变显示出更高的发育异常率。
染色内镜检查可轻松检测结肠黏膜病变，并有助于观察平坦病变的边界。该技术可发现常规电子结肠镜检查未识别的多个黏膜病变。染色后所见的凹窝模式可区分增生性和腺瘤性病变，这可能对所需的内镜干预产生影响。
