Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences.
Department of Gastroenterology, National Hospital Organization Iwakuni Clinical Center.
Acta Med Okayama. 2023 Oct;77(5):545-552. doi: 10.18926/AMO/65978.
To determine the endoscopic and clinical features of localized gastric amyloid light-chain (AL) amyloidosis, we retrospectively examined the characteristics of nine patients (eight men and one woman) encountered by the hospitals in our network. Lesions were predominantly flat and depressed with surface vascular dilatation (n=5); others were characterized by subepithelial lesions (n=2), mucosal color change (n=1), and a mass-like morphology with swollen mucosal folds (n=1). Colonoscopy (n=7), video capsule enteroscopy (n=2), serum (n=5) and urine immunoelectrophoresis (n=4), and bone marrow examination (n=3) were performed to exclude involvement of organs other than the stomach. As treatment for gastric lesions of AL amyloidosis, one patient each underwent endoscopic submucosal dissection (n=1) and argon plasma coagulation (n=1), while the remaining seven patients underwent no specific treatment. During a mean follow-up of 4.2 years, one patient died 3.2 years after diagnosis, but the cause of death, which occurred in another hospital, was unknown. The remaining eight patients were alive at the last visit. In conclusion, although localized gastric AL amyloidosis can show various macroscopic features on esophagogastroduodenoscopy, flat, depressed lesions with vascular dilatation on the surface are predominant.
为了确定局限性胃轻链（AL）淀粉样变的内镜和临床特征，我们回顾性分析了我们网络医院遇到的 9 例患者（8 名男性，1 名女性）的特征。病变主要为平坦凹陷，伴有表面血管扩张（n=5）；其他表现为黏膜下病变（n=2）、黏膜颜色改变（n=1）、黏膜皱襞肿胀呈肿块样形态（n=1）。进行了结肠镜检查（n=7）、视频胶囊内镜检查（n=2）、血清（n=5）和尿液免疫电泳（n=4）以及骨髓检查（n=3），以排除胃以外器官受累。作为 AL 淀粉样变性胃病变的治疗，1 例患者分别接受了内镜黏膜下剥离术（n=1）和氩等离子体凝固术（n=1），而其余 7 例患者未接受特定治疗。在平均 4.2 年的随访中，1 例患者在诊断后 3.2 年死亡，但在另一家医院死亡的原因未知。其余 8 例患者在最后一次就诊时仍存活。总之，尽管局限性胃 AL 淀粉样变在食管胃十二指肠镜下可呈现多种大体特征，但表面伴有血管扩张的平坦凹陷性病变更为常见。
