上消化道上皮内瘤变的内镜下特征

The endoscopic features of intraepithelial neoplasia in upper gastrointestinal

目的探讨上消化道上皮内瘤变(intraepithelial neoplasia,IN)的内镜下特点,提高上消化道早癌的检出率。方法收集2015年7月-2016年7月在西安交通大学第二附属医院因各种原因接受上消化内镜检查的3 676例患者的临床资料,其中检出不同级别的IN者35例,结合病理结果,分析上消化道IN的内镜下特征。结果主要累及部位是胃(22例),其次为食管(9例)、十二指肠(2例)、食管胃吻合口(1例)、残胃(1例),食管IN最常见的内镜下表现为黏膜粗糙,其次为黏膜糜烂,较少见的表现有黏膜颜色的改变及小结节样改变;胃病变中最常见的类型为平坦型(Ⅱ型),其次为凹陷型病变(Ⅱa+Ⅱc及Ⅰc)和隆起型病变(Ⅰa),白光内镜基础上,图像增强内镜(染色内镜、I-scan、BLI、LCI及NBI)有助于病变范围及深度的判断。结论白光内镜精查基础上,应用内镜图像增强技术,有助于提高IN及早癌的检出率。

Objective To investigate the endoscopic morphological features of intraepithelial neoplasia（IN）in upper gastrointestinal tract and the diagnostic rate of early stage cancer.Methods Among 3 676 patients who underwent esophagogastroduodenal endoscopy in the Second Affiliated Hospital of Xi＇an Jiaotong University from Jul.2015 to Jul.2016,35 cases were histopathological proved IN and early stage carcinoma,whose clinical data and the morphological features were collected and analyzed.Results The most involved site were stomach（22 cases）,followed by esophagus（9 cases）and duodenum（2 cases）,and 1 case esophagogastric anatomosis and 1 case gastric stump.Morphological feature of esophageal lesion included coarseness of mucosa,erosion and color change and nodular.The most common type of gastric lesion was flat type（typeⅡ）,then depressed type（Ⅱa＋Ⅱc,Ⅰc）and elevated type（Ⅰa）.Based on white light image（WLI）endoscopy,enhanced image endoscopy（chromoscopy,I-scan,BLI,LCI and NBI）was helpful in the area and depth of lesions.Conclusion Based on WLI precise endoscopy,enhanced image endoscopy can improve the diagnostic level of precancerous lesion and early stage carcinoma.