Toyoda Hideki, Rubio Carlos, Befrits Ragnar, Hamamoto Norihiro, Adachi Yukihiko, Jaramillo Edgar
Department of Gastroenterology and Hepatology, Karolinska Hospital, Stockholm, Sweden.
Gastrointest Endosc. 2004 Jan;59(1):15-21. doi: 10.1016/s0016-5107(03)02527-6.
Standard videoendoscopy identifies columnar-lined esophagus but cannot distinguish intestinal metaplasia from other types of epithelium. Enhanced-magnification endoscopy identifies different mucosal pit patterns. A preliminary study suggested that a type 3 pattern is associated with the presence of intestinal metaplasia. This study assesses the value of enhanced-magnification endoscopy for the detection of intestinal metaplasia in the distal esophagus and esophagogastric junction in patients undergoing diagnostic EGD.
Patients undergoing diagnostic endoscopy for upper-GI symptoms underwent enhanced-magnification endoscopy after instillation of 1.5% acetic acid. The enhanced-magnification endoscopy mucosal pattern was classified into 3 types: 1, normal pits; 2, slit-reticular pattern; and 3, gyrus-villous pattern. Preliminary studies indicated that the type 3 pattern was related to intestinal metaplasia. One to 6 biopsies were targeted to areas having a type 3 pattern in columnar-appearing mucosa in the distal esophagus or esophagogastric junction. In the absence of type 3 pattern, one to 8 biopsies were targeted to areas with a type 2 pattern in columnar-appearing mucosa in the distal esophagus or esophagogastric junction.
The overall frequency of intestinal metaplasia in the esophagus and esophagogastric junction was 38.8% (26/67 patients). There was a good correlation between the type 3 pattern and intestinal metaplasia in targeted biopsy specimens (sensitivity 88.5%, specificity 90.2%, positive predictive value 85.2%, negative predictive value 92.5%, overall accuracy 90.0%).
Enhanced-magnification endoscopy is useful for detection of intestinal metaplasia in distal esophagus and esophagogastric junction.
标准视频内镜检查可识别柱状上皮化生的食管，但无法区分肠化生与其他类型的上皮。放大内镜可识别不同的黏膜小凹形态。一项初步研究表明，3型形态与肠化生的存在有关。本研究评估放大内镜在接受诊断性上消化道内镜检查（EGD）的患者中检测远端食管和食管胃交界处肠化生的价值。
因上消化道症状接受诊断性内镜检查的患者在滴注1.5%醋酸后接受放大内镜检查。放大内镜下的黏膜形态分为3型：1型，正常小凹；2型，裂隙-网状形态；3型，脑回-绒毛状形态。初步研究表明，3型形态与肠化生有关。在远端食管或食管胃交界处柱状黏膜出现3型形态的区域取1至6块活检组织。若不存在3型形态，则在远端食管或食管胃交界处柱状黏膜出现2型形态的区域取1至8块活检组织。
食管和食管胃交界处肠化生的总体发生率为38.8%（26/67例患者）。靶向活检标本中3型形态与肠化生之间存在良好的相关性（敏感性88.5%，特异性90.2%，阳性预测值85.2%，阴性预测值92.5%，总体准确率90.0%）。
放大内镜有助于检测远端食管和食管胃交界处的肠化生。
