Yep-Gamarra Víctor, Díaz-Vélez Cristian, Araujo Isis, Ginès Àngels, Fernández-Esparrach Gloria
Hospital Regional Lambayeque, Perú
Dirección de investigación del Hospital Regional de Lambayeque, Facultad de Medicina, Universidad San Martín de Porres-Filial Norte. Perú
Gastroenterol Hepatol. 2016 Feb;39(2):49-54. doi: 10.1016/j.gastrohep.2015.08.005. Epub 2015 Nov 6.
Premalignant gastric lesions have an increased risk to develop gastric cancer.
To evaluate the usefulness of systematic endoscopy that includes chromoendoscopy with a double dye staining technique for the detection of dysplasia in patients with premalignant gastric lesions.
This longitudinal, prospective study was performed in patients with gastric atrophy, intestinal metaplasia or dysplasia who were referred for endoscopy less than 6 months after the initial diagnosis. The second endoscopy was performed in three phases: phase 1, exhaustive and systematic review of the mucosa with photographic documentation and biopsies of suspicious areas; phase 2, chromoendoscopy with a double dye staining technique using acetic acid 1.2% and indigo carmine 0.5%; phase 3, topographic mapping and random biopsies.
A total of 50 patients were included. Nine (18%) had atrophic gastritis, 38 (76%) had intestinal metaplasia, and 3 (6%) had low-grade dysplasia. Systematic endoscopy with chromoendoscopy using a double dye staining technique detected more patients with dysplasia (9 versus 3, p<.05), and a larger number of biopsies with the diagnosis of dysplasia were obtained. This occurred for visible (6 vs. 0, p<.05) and non-visible lesions (6 vs. 3, p=NS). In one patient, initial low-grade dysplasia was not detected again in the systematic endoscopy, giving a global endoscopic performance for the detection of lesions of 92%.
Patients with premalignant gastric lesions have synchronous lesions with greater histological severity, which are detected when systematic endoscopy is conducted with indigo carmine dye added to acetic acid.
癌前胃病变发展为胃癌的风险增加。
评估包括采用双染料染色技术的色素内镜检查在内的系统内镜检查对癌前胃病变患者发育异常的检测效用。
本纵向前瞻性研究针对初次诊断后不到6个月就接受内镜检查的胃萎缩、肠化生或发育异常患者进行。第二次内镜检查分三个阶段进行：第1阶段，对黏膜进行详尽系统的检查，对可疑区域进行拍照记录并活检；第2阶段，采用1.2%醋酸和0.5%靛胭脂的双染料染色技术进行色素内镜检查；第3阶段，进行地形图绘制和随机活检。
共纳入50例患者。9例（18%）患有萎缩性胃炎，38例（76%）患有肠化生，3例（6%）患有低度发育异常。采用双染料染色技术的色素内镜系统内镜检查发现更多发育异常患者（9例对3例，p<0.05），且获得更多诊断为发育异常的活检样本。可见病变（6例对0例，p<0.05）和不可见病变（6例对3例，p=无显著性差异）均如此。1例患者在系统内镜检查中未再次检测到初始的低度发育异常，病变检测的总体内镜表现为92%。
癌前胃病变患者存在组织学严重程度更高的同步病变，在醋酸中添加靛胭脂进行系统内镜检查时可检测到这些病变。
