Tamai N, Kaise M, Nakayoshi T, Katoh M, Sumiyama K, Gohda K, Yamasaki T, Arakawa H, Tajiri H
Department of Endoscopy, The Jikei University School of Medicine, Nishi-shinbashi, Tokyo, Japan.
Endoscopy. 2006 Apr;38(4):391-4. doi: 10.1055/s-2005-921207.
Depressed gastric adenoma remains poorly characterized because it is rare, and is infrequently detected by endoscopy. The aim of this study was to elucidate clinical and endoscopic characteristics of depressed adenoma of the stomach.
95 consecutive patients who underwent endoscopic resection of gastric adenomas were studied. Gastric adenomas, diagnosed according to the Vienna classification, were endoscopically classified into two types: depressed and protruding adenomas. In order to clarify endoscopic features of gastric adenomas, we performed indigo carmine chromoendoscopy as well as magnifying endoscopy with narrow band imaging, which yields clear images of mucosal microvasculature.
12% of 100 gastric adenomas resected from 95 patients were depressed adenomas. Age and gender were comparable between patients with each type. Depressed adenomas (15.9 +/- 6.2 mm) were significantly larger in diameter than protruding adenomas (10.6 +/- 8.0 mm) (P = 0.01). Half of depressed adenomas were reddish in color, whereas only 18% of protruding adenomas were reddish. Magnifying endoscopy with narrow band imaging showed that 71% of depressed adenomas had a regular ultrafine network pattern of mucosal microvasculature, which was not seen in protruding adenomas. Intramucosal carcinomas were more frequently found in depressed adenomas (25%) than in protruding adenomas (4.5%).
In comparison with protruding adenomas, depressed adenomas were rare and appeared endoscopically as large and reddish with a specific regular ultrafine network pattern of mucosal microvasculature. Depressed adenomas should be endoscopically resected because intramucosal carcinomas were found in a quarter of them.
凹陷型胃腺瘤较为罕见，且在内镜检查中不常被发现，因此其特征仍未得到充分描述。本研究旨在阐明胃凹陷型腺瘤的临床及内镜特征。
对95例连续接受胃腺瘤内镜切除术的患者进行研究。根据维也纳分类法诊断的胃腺瘤在内镜下分为两种类型：凹陷型腺瘤和隆起型腺瘤。为明确胃腺瘤的内镜特征，我们进行了靛胭脂染色内镜检查以及窄带成像放大内镜检查，后者可清晰显示黏膜微血管图像。
从95例患者中切除的100个胃腺瘤中，12%为凹陷型腺瘤。两种类型患者的年龄和性别无差异。凹陷型腺瘤（直径15.9±6.2mm）的直径显著大于隆起型腺瘤（直径10.6±8.0mm）（P=0.01）。凹陷型腺瘤中有一半呈红色，而隆起型腺瘤中只有18%呈红色。窄带成像放大内镜检查显示，71%的凹陷型腺瘤具有规则的黏膜微血管超微网络模式，而隆起型腺瘤中未见此现象。凹陷型腺瘤中黏膜内癌的发生率（25%）高于隆起型腺瘤（4.5%）。
与隆起型腺瘤相比，凹陷型腺瘤较为罕见，内镜下表现为体积较大、呈红色且具有特定的规则黏膜微血管超微网络模式。由于四分之一的凹陷型腺瘤中发现了黏膜内癌，因此应进行内镜切除。
