十二指肠胃黏膜异位症的临床特点及内镜诊断

Endoscopic and clinical characteristics of heterotopic gastric mucosa in duodenum

目的通过对65例十二指肠胃黏膜异位症的分析,探讨十二指肠胃黏膜异位(heterotopic gastric mucosa,HGM)内镜下表现及临床特点。方法选取2015年7月至2016年8月首都医科大学附属北京友谊医院消化内科经病理确诊为十二指肠胃黏膜异位的65例患者进行临床病理及内镜诊断分析。结果内镜下十二指肠HGM多发生于十二指肠球部前壁(44.6%)。白光内镜下表现主要有3型:单发或多发息肉样增生型47例(72.3%);簇状小结节样隆起型11例(16.9%);扁平隆起型6例(9.2%);此外,有1例(1.5%)呈散在充血红斑,似球炎样表现。息肉样增生型多容易误诊为十二指肠息肉;而扁平隆起型则不易与黏膜下肿瘤及十二指肠肿瘤相鉴别,超声内镜和放大内镜对两者的鉴别诊断有很大价值。临床治疗仍以内镜下息肉电切为主。结论十二指肠HGM内镜表现多种多样,应结合组织学检查,减少误诊和漏诊。放大内镜可作为新的辅助诊断方法。

Objective To analyze 65 cases of heterotopic gastric mucosa(HGM)in duodenum and investigated the endoscopic and clinical characteristics of HGM in duodenum.Methods Clinical and endoscopic data about 65 patients with pathology-confirmed HGM in duodenum admitted to our hospital from July 2015 to August 2016 were retrospectively analyzed.Results HGM of duodenum was mainly located on the anterior wall of duodenal bulb.The morphology was mainly divided into 3 types:the single or multiple polypoid hyperplasia type in 47 patients(72.3%),clustered nodule type in 11 patients(16.9%),flat elevated type in 6 patients(9.2%).One patient(1.5%)had congestive erythematous lesion,which like duodenitis.Polypoid hyperplasia type was often misdiagnosed as duodenal polyp,while flat elevated type was difficult to be distinguished from tumor and submucosal tumor in duodenum.And it is meaningful to distinguish the atypical HGM via using endoscopic ultrasound(EUS)and magnifying endoscopy with narrow-band imaging(M-NBI).Endoscopic polypectomy is still the main method of clinical treatment in HGM.Conclusion There are many kinds of endoscopic manifestations of duodenal HGM.Combined with histological examination and endoscopic findings,misdiagnosis should be reduced.Magnifying endoscopy with narrow-band imaging may be the new and useful method in differentiating HGM in duodenum.