Imaeda Hiroyuki, Hosoe Naoki, Kashiwagi Kazuhiro, Ida Yosuke, Nakamura Rieko, Suzuki Hidekazu, Saito Yoshimasa, Yahagi Naohisa, Iwao Yasushi, Kitagawa Yuko, Hibi Toshifumi, Ogata Haruhiko, Kanai Takanori
Hiroyuki Imaeda, Department of General Internal Medicine, Saitama Medical University, Saitama 350-0495, Japan.
World J Gastroenterol. 2014 Nov 21;20(43):16311-7. doi: 10.3748/wjg.v20.i43.16311.
To evaluate the effectiveness of trimodal imaging endoscopy (TME) to detect another lesion after endoscopic submucosal dissection (ESD) for superficial gastric neoplasia (SGN).
Surveillance esophagogastroduodenoscopy (EGD) using a TME was conducted in 182 patients that had undergone ESD for SGN. Autofluorescence imaging (AFI) was conducted after white-light imaging (WLI). When SGN was suspicious, magnifying endoscopy with narrow-band imaging (ME-NBI) was conducted. Final diagnoses were made by histopathologic findings of biopsy specimens. The detection rates of lesions in WLI, AFI, and NBI, and the characteristics of lesions detected by WLI and ones missed by WLI but detected by AFI were examined. The sensitivity, specificity, and accuracy of endoscopic diagnosis using WLI, AFI and ME-NBI were evaluated.
In 242 surveillance EGDs, 27 lesions were determined pathologically to be neoplasias. Sixteen early gastric cancers and 6 gastric adenomas could be detected by WLI. Sixteen lesions were reddish and 6 were whitish. Five gastric neoplasias were missed by WLI but were detected by AFI, and all were whitish and protruded gastric adenomas. There was a significant difference in color and pathology between the two groups (P = 0.006). Sensitivity, specificity and accuracy in ME-NBI were higher than those in both WLI and AFI. Specificity and accuracy in AFI were lower than those in WLI.
Surveillance using trimodal imaging endoscopy might be useful for detecting another lesion after endoscopic submucosal dissection for superficial gastric neoplasia.
评估三模态成像内镜检查（TME）用于检测浅表性胃肿瘤（SGN）内镜黏膜下剥离术（ESD）后其他病变的有效性。
对182例接受ESD治疗SGN的患者进行了使用TME的食管胃十二指肠镜监测（EGD）。在白光成像（WLI）后进行自体荧光成像（AFI）。当SGN可疑时，进行窄带成像放大内镜检查（ME-NBI）。最终诊断依据活检标本的组织病理学结果。检查了WLI、AFI和NBI中病变的检出率，以及WLI检测到的病变和WLI漏检但AFI检测到的病变的特征。评估了使用WLI、AFI和ME-NBI进行内镜诊断的敏感性、特异性和准确性。
在242次监测EGD中，病理确定有27个病变为肿瘤。WLI可检测到16例早期胃癌和6例胃腺瘤。16个病变呈红色，6个呈白色。5个胃肿瘤WLI漏检但AFI检测到，均为白色突出型胃腺瘤。两组在颜色和病理方面存在显著差异（P = 0.006）。ME-NBI的敏感性、特异性和准确性高于WLI和AFI。AFI的特异性和准确性低于WLI。
三模态成像内镜监测可能有助于检测浅表性胃肿瘤内镜黏膜下剥离术后的其他病变。
