Morales T G, Bhattacharyya A, Camargo E, Johnson C, Sampliner R E
Arizona Health Sciences Center, Tucson Veterans Administration Medical Center, 85724, USA.
Gastrointest Endosc. 1998 Jul;48(1):26-31. doi: 10.1016/s0016-5107(98)70124-5.
Previous studies by our group have identified a 23% prevalence of intestinal metaplasia involving the gastric cardia in patients undergoing elective esophagogastroduodenoscopy (EGD). The current study evaluates the potential clinical utility of vital staining with methylene blue for detecting intestinal metaplasia of the cardia. In addition, the prevalence of Helicobacter pylori infection and incidence of dysplasia in cardia intestinal metaplasia was assessed.
Twenty-four of 104 patients undergoing elective EGD were previously identified with cardia intestinal metaplasia. Twenty-one of these 24 returned for follow-up EGD with methylene blue staining and cardia biopsies. During EGD four random biopsies were taken in the cardia. After staining with methylene blue, four targeted biopsy specimens were taken from any stained areas. H. pylori infection was assessed by rapid urease testing and serologic evaluation.
Staining with methylene blue was positive in 16, equivocal in 4, and negative in 1. Overall, cardia intestinal metaplasia was identified in 17 of 21 patients (81%) by at least one of the 8 biopsies. The sensitivity of detecting intestinal metaplasia by targeted biopsies to stained areas was 67% as opposed to 38% for random biopsies (odds ratio 3.0: 95% CI [0.88,10.24]). The prevalence of H. pylori infection in patients with cardia intestinal metaplasia was 76%. One patient developed low-grade dysplasia, whereas the others remained negative.
Intestinal metaplasia of the gastric cardia is associated with a high prevalence of H. pylori infection and is a reproducible finding in the majority of patients. Methylene blue staining and an increasing number of biopsies improve the sensitivity of detecting this potentially neoplastic lesion.
我们团队之前的研究发现，在接受选择性食管胃十二指肠镜检查（EGD）的患者中，胃贲门部肠化生的患病率为23%。本研究评估了亚甲蓝活体染色检测贲门部肠化生的潜在临床效用。此外，还评估了幽门螺杆菌感染的患病率以及贲门部肠化生中发育异常的发生率。
104例接受选择性EGD的患者中有24例之前被诊断为贲门部肠化生。这24例患者中有21例返回接受亚甲蓝染色及贲门活检的随访EGD检查。在EGD检查期间，在贲门部随机取4块活检组织。用亚甲蓝染色后，从任何染色区域取4块靶向活检标本。通过快速尿素酶试验和血清学评估来评估幽门螺杆菌感染情况。
亚甲蓝染色阳性16例，可疑4例，阴性1例。总体而言，21例患者中有17例（81%）通过8次活检中的至少一次被诊断为贲门部肠化生。靶向活检染色区域检测肠化生的敏感性为67%，而随机活检的敏感性为38%（优势比3.0：95%置信区间[0.88,10.24]）。贲门部肠化生患者中幽门螺杆菌感染的患病率为76%。1例患者发生低级别发育异常，其他患者仍为阴性。
胃贲门部肠化生与幽门螺杆菌感染的高患病率相关，并且在大多数患者中是可重复的发现。亚甲蓝染色和增加活检次数可提高检测这种潜在肿瘤性病变的敏感性。
