Asan Digestive Disease Research Institute, Departments of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Helicobacter. 2012 Dec;17(6):405-10. doi: 10.1111/j.1523-5378.2012.00972.x. Epub 2012 Jul 11.
Helicobacter pylori eradication is essential for metachronous gastric cancer prevention in patients undergoing endoscopic mucosectomy (EMR). This study was aimed to determine the optimal biopsy site for H. pylori detection in the atrophic remnant mucosa of EMR patients.
Data were analyzed from 91 EMR patients. Three paired biopsies for histology were taken at antrum, corpus lesser (CLC), and greater curve (CGC). Additional specimens were obtained at antrum and CGC for rapid urease test (RUT). H. pylori infection was defined as at least two positive specimens on histology and/or RUT. Serologic atrophy was determined by pepsinogen levels.
Overall H. pylori infection rate was 72.5%. The proportions of moderate-to-marked atrophy/intestinal metaplasia at CGC (5.6/6.6%) were significantly lower than those at antrum (58.6/75.8%) and CLC (60.7/70.0%). Sensitivity of histology in detecting H. pylori was significantly higher at CGC than at antrum and CLC (84.8 vs 30.3 and 47.0%, respectively; p < .001). On RUT, detection at CGC also showed higher sensitivity than at antrum (77.3 vs 33.3%, p < .001). Specificities of all three biopsy sites were more than 90%. Regardless of serologic atrophy, CGC showed consistently higher sensitivities on histology and RUT. In patients with serologic atrophy, antral sensitivities were much lower than those of nonatrophic patients, 9.5 versus 40.0% on histology (p = .012) and 14.3 versus 42.2% on RUT (p = .025).
CGC is the optimal biopsy site for H. pylori diagnosis in EMR patients with extensive atrophy. Antral biopsy should be avoided, especially in serologically atrophic patients.
幽门螺杆菌（H. pylori）根除对于内镜黏膜下剥离术（EMR）后发生的胃黏膜异型增生和胃癌的预防至关重要。本研究旨在明确在 EMR 后患者的萎缩性残胃黏膜中，用于检测 H. pylori 的最佳活检部位。
对 91 例行 EMR 的患者的数据进行了分析。于胃窦、胃体小弯（CLC）和胃体大弯（CGC）处分别进行 3 对活检以进行组织学检查，另外于胃窦和 CGC 处取标本进行快速尿素酶试验（RUT）。将组织学和/或 RUT 至少有 2 项阳性的结果定义为 H. pylori 感染。通过胃蛋白酶原水平确定血清学萎缩情况。
总体 H. pylori 感染率为 72.5%。CGC 处中-重度萎缩/肠化生的比例（5.6%/6.6%）明显低于胃窦（58.6%/75.8%）和 CLC（60.7%/70.0%）（p<0.001）。胃窦和 CLC 处的组织学检测 H. pylori 的敏感度均显著低于 CGC（84.8%比 30.3%和 47.0%，p<0.001）。CGC 处的 RUT 检测敏感度也显著高于胃窦（77.3%比 33.3%，p<0.001）。所有 3 个活检部位的特异性均>90%。无论血清学是否萎缩，组织学和 RUT 检测在 CGC 处的敏感度均始终较高。在血清学萎缩的患者中，胃窦处的组织学检测敏感度明显低于非萎缩患者（9.5%比 40.0%，p=0.012）和 RUT 检测敏感度（14.3%比 42.2%，p=0.025）。
对于广泛萎缩的 EMR 患者，CGC 是检测 H. pylori 的最佳活检部位。应避免胃窦活检，尤其是在血清学萎缩的患者中。
