Iwagami Hiroyoshi, Uedo Noriya, Yip Hon-Chi, Shichijo Satoki, Kanesaka Takashi, Maekawa Akira, Yamamoto Sachiko, Higashino Koji, Takeuchi Yoji, Ishihara Ryu, Nakatsuka Shin-Ichi
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
Division of Upper Gastro-intestinal and Metabolic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
Endosc Int Open. 2021 Apr;9(4):E522-E529. doi: 10.1055/a-1352-2500. Epub 2021 Mar 17.
Narrow-band imaging (NBI) with or without magnification has recently been used for diagnosis of gastric intestinal metaplasia (GIM). Endocytoscopy is a newly developed endoscopic technique that enables ultra-high (500 ×) magnification of the digestive tract mucosa. This study aimed to analyze the ultra-magnifying NBI characteristics of GIM. This was a retrospective observational study conducted in a cancer referral center. Patients who underwent ultra-magnifying NBI of the gastric mucosa using endocytoscopy were eligible. A soft black cap was used for non-contact observation. We compared the characteristic findings of GIM by ultra-magnifying NBI of metaplastic and non-metaplastic mucosae. A reference standard for GIM in this study was conventional magnifying NBI findings of GIM. We obtained 28 images of metaplastic mucosa and 32 of non-metaplastic mucosa from 38 patients. Ultra-magnifying NBI revealed the cobblestone-like cellular structure in the marginal crypt epithelium of metaplastic and non-metaplastic mucosa. Diagnostic values (sensitivity, specificity, accuracy and kappa value [95 % confidence interval]) for the heterogeneous cellular structure and rough contour of the marginal crypt epithelium were 82 % (68 %-96 %), 94 % (85 %-100 %), 88 % (80 %-96 %), and 0.70, and 86 % (73 %-99 %), 94 % (85 %-100 %), 90 % (82 %-98 %), and 0.71, respectively. The characteristic ultrastructural features of GIM were identified by ultra-magnifying NBI, warranting validation of diagnostic value in a prospective study.
窄带成像（NBI）无论有无放大功能，最近都已用于诊断胃肠化生（GIM）。内镜细胞成像术是一种新开发的内镜技术，可实现消化道黏膜的超高（500倍）放大。本研究旨在分析GIM的超高倍放大NBI特征。这是一项在癌症转诊中心进行的回顾性观察研究。符合条件的患者需接受使用内镜细胞成像术对胃黏膜进行超高倍放大NBI检查。使用软质黑帽进行非接触观察。我们通过对化生和非化生黏膜进行超高倍放大NBI，比较了GIM的特征性表现。本研究中GIM的参考标准是GIM的传统放大NBI表现。我们从38例患者中获取了28张化生黏膜图像和32张非化生黏膜图像。超高倍放大NBI显示化生和非化生黏膜边缘隐窝上皮的鹅卵石样细胞结构。边缘隐窝上皮细胞结构异质性和轮廓粗糙的诊断价值（敏感性、特异性、准确性和kappa值[95%置信区间]）分别为82%（68%-96%）、94%（85%-100%）、88%（80%-96%）和0.70，以及86%（73%-99%）、94%（85%-100%）、90%（82%-98%）和0.71。通过超高倍放大NBI识别出了GIM的特征性超微结构特征，有待在前瞻性研究中验证其诊断价值。
