Endo Takao, Awakawa Teruhito, Takahashi Hiroaki, Arimura Yoshiaki, Itoh Fumio, Yamashita Kentaro, Sasaki Sigeru, Yamamoto Hiroyuki, Tang Xiufen, Imai Kohzoh
First Department of Internal Medicine, Sapporo Medical University, Sapporo 060, Japan.
Gastrointest Endosc. 2002 May;55(6):641-7. doi: 10.1067/mge.2002.123420.
The specialized columnar epithelium of Barrett's esophagus can be detected by obtaining random or 4 quadrant biopsy specimens at conventional endoscopy. However, little is known about the fine mucosal structure of specialized columnar epithelium.
Thirty patients with Barrett's esophagus were studied by magnifying endoscopy. The fine mucosal pattern (pit pattern) of 67 regions in Barrett's mucosa was recorded and compared with methylene blue staining. Histologic, mucin immunohistologic, and cell proliferation analyses of biopsy specimens were performed in relation to the pit patterns determined by magnifying endoscopy.
Pit pattern was classified into 5 types. Tubular and villous pit patterns were not only characteristics of both specialized columnar epithelium and methylene blue absorption, but also possessed an intestinal mucin phenotype with a high Ki-labeling index, whereas other pit patterns (dot and straight) did not have specialized columnar epithelium and were categorized as the gastric phenotype. The long oval pit pattern had an intermediate phenotype between gastric and intestinal.
The classification of the superficial mucosal appearance of Barrett's epithelium by magnifying endoscopy reflects not only histologic features but also mucin phenotypes.
在传统内镜检查中，通过获取随机或四象限活检标本可检测出巴雷特食管的特殊柱状上皮。然而，对于特殊柱状上皮的精细黏膜结构知之甚少。
对30例巴雷特食管患者进行放大内镜检查研究。记录巴雷特黏膜67个区域的精细黏膜形态（凹坑形态），并与亚甲蓝染色结果进行比较。对活检标本进行组织学、黏蛋白免疫组织学及细胞增殖分析，并与放大内镜确定的凹坑形态相关联。
凹坑形态分为5种类型。管状和绒毛状凹坑形态不仅是特殊柱状上皮和亚甲蓝吸收的特征，还具有高Ki标记指数的肠型黏蛋白表型，而其他凹坑形态（点状和直线状）则没有特殊柱状上皮，被归类为胃型表型。长椭圆形凹坑形态具有介于胃型和肠型之间的中间表型。
通过放大内镜对巴雷特上皮表面黏膜外观进行分类，不仅反映了组织学特征，还反映了黏蛋白表型。
