Caletti G, Fusaroli P, Bocus P
Dept. of Medicine and Gastroenterology, University of Bologna, Italy.
Endoscopy. 1998 Aug;30 Suppl 1:A72-5. doi: 10.1055/s-2007-1001476.
Large gastric folds are seen in a great number of benign and malignant conditions. Diagnosis is a clinical challenge because the etiology may be extremely varied and standard biopsies are often inconclusive. The gastric wall is considered thickened at endosonography when it is more than 3.6 mm in width. Different diseases show different levels of infiltration of the gastric wall. When abnormalities involve the second layer only, benign conditions can be considered and standard endoscopic biopsies are often diagnostic. When abnormalities involve layers two and three, different diseases can be suspected, including Helicobacter pylori infection and lymphoma; in this case large-particle biopsy should be considered. When abnormalities involve layer four, malignancy should be strongly suspected even if standard or large-particle biopsies are negative. Endosonography, always in combination with fine-needle or guillotine-needle biopsy, should be able to rule out malignancies and to select the most appropriate treatment for each patient.
大量良性和恶性疾病均可出现胃黏膜皱襞粗大。诊断颇具临床挑战性，因为病因可能极为多样，且标准活检往往无法得出明确结论。当胃壁在超声内镜下宽度超过3.6mm时，即被认为增厚。不同疾病显示胃壁的浸润程度不同。当异常仅累及第二层时，可考虑为良性疾病，标准内镜活检通常具有诊断价值。当异常累及第二层和第三层时，可能怀疑多种不同疾病，包括幽门螺杆菌感染和淋巴瘤；在此情况下，应考虑进行大颗粒活检。当异常累及第四层时，即使标准或大颗粒活检为阴性，也应高度怀疑恶性肿瘤。超声内镜检查始终应与细针或切割针活检相结合，应能够排除恶性肿瘤，并为每位患者选择最合适的治疗方法。
