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幽门螺杆菌根除后胃黏膜红色凹陷性病变的临床意义。

Clinical Significance of Reddish Depressed Lesions Observed in the Gastric Mucosa after Helicobacter pylori Eradication.

机构信息

Department of Medicine and Molecular Science, Hiroshima University, Hiroshima, Japan.

Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.

出版信息

Digestion. 2018;98(1):48-55. doi: 10.1159/000487045. Epub 2018 Apr 19.

Abstract

BACKGROUND AND AIM

Reddish depressed lesions (RDLs) frequently observed in patients following Helicobacter pylori eradication are indistinguishable from gastric cancer. We examined the clinical and histological feature of RDLs and its relevant endoscopic diagnosis including magnifying narrow-band imaging (M-NBI).

METHODS

We enrolled 301 consecutive patients with H. pylori eradication who underwent endoscopy using white light imaging (WLI). We examined the prevalence and host factors contributing to the presence of RDLs. Next, we used M-NBI in 90 patients (104 RDLs), and compared the diagnostic efficacy between M-NBI and WLI groups using propensity-score matching analysis.

RESULTS

In 301 patients after eradication, 117 (39%) showed RDLs. Male, open-type atrophy, and gastric cancer history were risk factors for RDLs. A gastric biopsy was needed in 83 (71%) during WLI observation and only 2 were diagnosed with adenocarcinoma. In M-NBI group, a biopsy was performed in 21 (20%), and 9 were diagnosed with adenocarcinoma. A biopsy was required in fewer patients, and the positive predictive value of a biopsy was statistically higher in M-NBI than in the WLI group (p < 0.01).

CONCLUSIONS

RDLs are frequently observed in high-risk patients for gastric cancer after eradication. M-NBI demonstrated significantly superior diagnostic efficacy with respect to RDL.

摘要

背景与目的

在幽门螺杆菌根除治疗后,常观察到患者出现红色凹陷性病变(RDLs),这些病变与胃癌难以区分。我们检查了 RDL 的临床和组织学特征及其相关的内镜诊断,包括放大窄带成像(M-NBI)。

方法

我们纳入了 301 例连续接受白光内镜(WLI)检查的幽门螺杆菌根除治疗患者。我们检查了 RDL 的患病率以及与 RDL 存在相关的宿主因素。然后,我们对 90 例患者(104 个 RDLs)使用 M-NBI,并用倾向评分匹配分析比较了 M-NBI 和 WLI 组之间的诊断效能。

结果

在 301 例根除治疗后的患者中,117 例(39%)出现 RDLs。男性、开放型萎缩和胃癌病史是 RDLs 的危险因素。在 WLI 观察期间,83 例(71%)需要进行胃活检,仅 2 例诊断为腺癌。在 M-NBI 组中,21 例(20%)进行了活检,9 例诊断为腺癌。M-NBI 组需要进行活检的患者更少,活检的阳性预测值在 M-NBI 组显著高于 WLI 组(p<0.01)。

结论

RDLs 在根除治疗后发生胃癌的高危患者中较为常见。M-NBI 对 RDL 的诊断效能明显优于 WLI。

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