Ortner M-A E J, Ebert B, Hein E, Zumbusch K, Nolte D, Sukowski U, Weber-Eibel J, Fleige B, Dietel M, Stolte M, Oberhuber G, Porschen R, Klump B, Hörtnagl H, Lochs H, Rinneberg H
4th Medical Department, Charité University Hospital, Humboldt University, Berlin, Germany.
Gut. 2003 Jan;52(1):28-33. doi: 10.1136/gut.52.1.28.
Specialised intestinal metaplasia and its dysplastic transformation, which precedes cancer in Barrett's oesophagus cannot be differentiated in standard gastroscopy. The aim of this study was to investigate whether laser induced protoporphyrin IX fluorescence permits the detection of specialised intestinal metaplasia and dysplasia during endoscopy and to take biopsy specimens in a guided rather than random manner.
In 53 patients with Barrett's oesophagus 5-aminolaevulinic acid was sprayed on the mucosa. Approximately 60 to 120 minutes later, biopsy specimens were taken based on point-like measurements of delayed fluorescence intensity ratios of protoporphyrin IX in vivo. Two independent pathologists examined the 596 biopsy specimens taken, 168 of which were selected to be investigated by a third pathologist. Among these specimens only those (n=141) with a consensus diagnosis by at least two pathologists and p53 expression as additional marker were included in the analysis.
The median of normalised fluorescence intensity (ratio of delayed PpIX fluorescence intensity to immediate autofluorescence intensity) in non-dysplastic specialised intestinal metaplasia (0.51, 68% CI 0.09 to 1.92) and low grade dysplasia (1.89, 68% CI 0.55 to 3.92) differed significantly (p<0.005). Dysplasia was detected at a rate 2.8-fold higher compared with screening endoscopy despite taking fewer specimens. In addition, three early cancers were detected for the first time. Moreover, this method permitted differentiation of specialised intestinal metaplasia from junctional or gastric-fundic type epithelium (p<0.013).
For the first time it was possible to differentiate low grade dysplasia from non-dysplastic Barrett's mucosa during endoscopy based on delayed laser induced fluorescence endoscopy of PpIX. Furthermore, the method helps to detect specialised intestinal metaplasia in short Barrett's oesophagus.
在巴雷特食管中，先于癌症出现的特殊肠化生及其发育异常转变在标准胃镜检查中无法区分。本研究的目的是调查激光诱导原卟啉IX荧光是否能在内镜检查期间检测出特殊肠化生和发育异常，并以引导而非随机的方式获取活检标本。
对53例巴雷特食管患者的黏膜喷洒5-氨基乙酰丙酸。约60至120分钟后，根据体内原卟啉IX延迟荧光强度比的点状测量结果获取活检标本。两名独立病理学家检查了所获取的596份活检标本，其中168份由第三名病理学家进行研究。在这些标本中，仅纳入那些至少有两名病理学家达成共识诊断且以p53表达作为额外标志物的标本（n = 141）进行分析。
非发育异常的特殊肠化生（0.51，68%可信区间0.09至1.92）和低级别发育异常（1.89，68%可信区间0.55至3.92）的标准化荧光强度中位数（延迟的原卟啉IX荧光强度与即时自发荧光强度之比）差异显著（p < 0.005）。尽管获取的标本较少，但与筛查性内镜检查相比，发育异常的检出率高出2.8倍。此外，首次检测出3例早期癌症。而且，该方法能够区分特殊肠化生与交界型或胃底型上皮（p < 0.013）。
首次有可能在内镜检查期间基于原卟啉IX的延迟激光诱导荧光内镜检查区分低级别发育异常与非发育异常的巴雷特黏膜。此外，该方法有助于在短节段巴雷特食管中检测出特殊肠化生。
