内镜在疑似萎缩性胃炎伴或不伴肠上皮化生与组织病理学比较中的作用。

Role of endoscopy in suspicion of atrophic gastritis with and without intestinal metaplasia in comparison to histopathology.

机构信息

Tropical Medicine Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt.

Pathology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt.

出版信息

Acta Gastroenterol Belg. 2021 Jan-Mar;84(1):9-17. doi: 10.51821/84.1.208.

DOI:10.51821/84.1.208

PMID:33639688

Abstract

BACKGROUND AND STUDY AIMS

Atrophic gastritis (AG) and intestinal metaplasia (IM) are established premalignant gastric lesions. Many studies documented a poor correlation between esophagogastroduodenoscopy (EGD) and histopathological (HP) findings of precancerous gastric lesions. The aim was to bridge the gap between endoscopy and HP in detection of chronic gastritis, AG and IM.

PATIENTS AND METHODS

a prospective single-center study involved 150 patients with endoscopic criteria of gastric lesions with upper gastrointestinal symptoms referred for upper GI endoscopy met the endoscopic criteria and classified according to HP of biopsies from targeted gastric lesions into chronic gastritis (GI), AG(GII) or IM(GIII). We correlated the endoscopic criteria of the 3 groups with the HP results.

RESULTS

(73 males & 75 females) with ages ranged17-75 years and mean± SD was 41.96 ± 15.95. GI, GII & GIII were [42 patients (28%),82 patients (54.7%) and 26 patients (17.3%)], respectively. Diffuse gastric mottling was more common in GI (74.3%, P<0.001), visible submucosal vessels, gastric atrophy predominated in GII (75.6, 82.3 & 73.1% (P 0.005,0.4 & <0.01)), respectively. Whitish raised lesions were more specific in GIII (85.7%) (P<0.001). The sensitivity and specificity of endoscopic suspicion of chronic gastritis were (86&88% in GI), (87&85% in GII) and (54% & 100% in GIII) (p-0.001). The logistic regression model for risk factors was χ2= 25.74 and 49.32, p < 0.001.

CONCLUSION

Conventional endoscopy has high sensitivity and specificity for suspicion of chronic gastritis and AG, but low sensitivity and very high specificity for IM. Targeted biopsies may be valuable with image enhanced techniques.

摘要

背景与研究目的

萎缩性胃炎（AG）和肠上皮化生（IM）是公认的胃癌前病变。许多研究表明，内镜和胃黏膜活检的胃癌前病变检查结果之间相关性较差。本研究旨在弥合内镜和胃黏膜活检在慢性胃炎、AG 和 IM 检测方面的差距。

患者与方法

这是一项前瞻性单中心研究，纳入了 150 例因上消化道症状而行上消化道内镜检查、并符合胃内病变内镜标准的患者。根据靶向胃黏膜活检的幽门螺杆菌（HP）结果，将患者分为慢性胃炎（GI）、AG（GII）或 IM（GIII）。我们将 3 组的内镜标准与 HP 结果进行了相关性分析。

结果

共纳入 150 例患者，其中男 73 例，女 75 例，年龄 17-75 岁，平均年龄（41.96±15.95）岁。GI、GII 和 GIII 患者分别为 42 例（28%）、82 例（54.7%）和 26 例（17.3%）。弥漫性胃黏膜斑片样改变在 GI 中更为常见（74.3%，P<0.001），可见黏膜下血管、胃萎缩在 GII 中更为常见（75.6%、82.3%和 73.1%（P<0.005、0.4 和 <0.01））。白色隆起性病变在 GIII 中更为特异（85.7%）（P<0.001）。内镜怀疑慢性胃炎的敏感性和特异性分别为 GI（86%、88%）、GII（87%、85%）和 GIII（54%、100%）（P<0.001）。危险因素的 logistic 回归模型 χ2=25.74 和 49.32，P<0.001。