Mendis R E, Gerdes H, Lightdale C J, Botet J F
Gastroenterology and Nutrition Service, Memorial Sloan Kettering Cancer Center, Cornell University Medical College, New York, New York 10021.
Gastrointest Endosc. 1994 Jul-Aug;40(4):437-41. doi: 10.1016/s0016-5107(94)70246-2.
The evaluation of large gastric folds poses a difficult diagnostic problem. Exploratory laparotomy with full-thickness gastric biopsy is frequently required in order to rule out malignancy. To examine the utility of endoscopic ultrasonography in the diagnostic evaluation of large gastric folds, 28 consecutive patients with endoscopically or radiographically diagnosed large gastric folds were studied; in most of these patients endoscopic biopsies had been inconclusive for malignancy. Sixteen subjects were women and 12 were men, with a mean age of 57 years (range, 23 to 84). All patients underwent endoscopic ultrasonography to determine the anatomic wall layer of enlargement; large-forceps biopsy with histopathologic review was then performed when appropriate. Endoscopic ultrasonography demonstrated enlargement of layer 2 only (deep mucosa) in 64% (18/28) of patients, primarily of layer 3 (submucosa) in 14% (4/28), and of layer 4 (muscularis propria) in 21% (6/28). Large-forceps endoscopic biopsy performed immediately after ultrasonography in 86% (24/28) revealed acute or chronic inflammation in 67% (16/24), malignancy in 16% (4/24), and Ménétrier's disease in 4% (1/24). The biopsy results of 3 patients (13%) were negative for malignancy, but because of ultrasonographic findings of wall thickening involving layers 3 and 4 (submucosa and muscularis propria), they underwent laparotomy, which revealed primary gastric adenocarcinoma. Endoscopic ultrasonography demonstrated gastric varices in 4 patients; biopsy specimens were not taken. One patient with gastric lymphoma had only a layer 2 abnormality, but the correct diagnosis was made by endoscopic biopsy. Malignancy did not develop in any of the patients with gastric wall thickening limited to layer 2 and negative biopsy results during a mean follow-up period of 35 months.(ABSTRACT TRUNCATED AT 250 WORDS)
对巨大胃皱襞的评估是一个诊断难题。为排除恶性肿瘤，常需进行 exploratory laparotomy 及全层胃活检。为研究内镜超声在巨大胃皱襞诊断评估中的作用，对 28 例经内镜或放射学诊断为巨大胃皱襞的连续患者进行了研究；这些患者中大多数内镜活检对恶性肿瘤的诊断尚无定论。16 例为女性，12 例为男性，平均年龄 57 岁（范围 23 至 84 岁）。所有患者均接受内镜超声检查以确定增厚的解剖壁层；然后在适当情况下进行大钳活检并进行组织病理学检查。内镜超声显示，64%（18/28）的患者仅第 2 层（深层黏膜）增厚，14%（4/28）主要是第 3 层（黏膜下层）增厚，21%（6/28）是第 4 层（固有肌层）增厚。86%（24/28）的患者在超声检查后立即进行大钳内镜活检，结果显示 67%（16/24）为急性或慢性炎症，16%（4/24）为恶性肿瘤，4%（1/24）为门脉高压性胃病。3 例患者（13%）的活检结果为恶性肿瘤阴性，但由于超声检查发现第 3 和第 4 层（黏膜下层和固有肌层）壁增厚，他们接受了剖腹手术，结果显示为原发性胃腺癌。4 例患者经内镜超声显示有胃静脉曲张；未取活检标本。1 例胃淋巴瘤患者仅第 2 层有异常，但通过内镜活检做出了正确诊断。在平均 35 个月的随访期内，胃壁增厚仅限于第 2 层且活检结果为阴性的患者均未发生恶性肿瘤。（摘要截短于 250 字）
