醋酸染色内镜下增强白化征及延迟褪色现象诊断胃黏膜肠上皮化生和癌变的有效性

Efficacy of severe whitening and delayed fading in acetic acid-enhanced chromoendoscopy for diagnosing gastric intestinal metaplasia

目的 探讨醋酸染色内镜下增强白化征及延迟褪色现象诊断胃黏膜肠上皮化生(GIM)和癌变的有效性。方法 选取2020年5月至2021年5月间西安国际医学中心医院消化内镜诊疗中心接受胃镜检查的91例患者作为研究对象,给予普通白光内镜检查、醋酸染色内镜检查。观察醋酸染色后增强白化征及延迟褪色现象,并给予病理活检,判定醋酸染色内镜下增强白化征及延迟褪色现象诊断胃黏膜肠上皮化生和癌变的有效性。结果 91例患者顺利完成研究方案,共有202个部位被纳入活检,99处被组织病理学证实为GIM。就增强白化征而言,诊断的敏感性、特异度、阳性预测值、阴性预测值和准确度分别为87.9%、90.3%、89.7%、88.6%和89.1%。延迟褪色现象对诊断的敏感性、特异度、阳性预测值、阴性预测值和准确度分别为88.9%、87.4%、87.1%、89.1%和88.1%。就普通白光内镜而言,对胃黏膜肠上皮化生诊断的敏感性、特异度、阳性预测值、阴性预测值和准确度分别为41.4%、90.3%、80.4%、61.6%和66.3%,醋酸染色内镜对胃黏膜肠上皮化生诊断的敏感性、特异度、阳性预测值、阴性预测值和准确度分别为88.9%、94.2%、91.7%、91.5%和91.6%。醋酸染色内镜诊断胃黏膜肠上皮化生的敏感性、准确度均高于普通白光内镜,差异均有统计学意义(均P<0.05)。结论 醋酸染色内镜下增强白化征及延迟褪色现象诊断胃黏膜肠上皮化生和癌变是一种简单可行、敏感性高、准确度高的检查手段,值得临床推广。

Objective To investigate the effectiveness severe whitening and delayed fading in acetic acid-enhanced chromoendoscopy for diagnosing gastric intestinal metaplasia. Methods Nine-one patients who underwent gastroscopy at Endoscopy Center for Gastrointestinal Disease Diagnosis and Treatment, Xi’an International Medical Center Hospital from May 2020 to May 2021 were selected. They were examined with standard white light and acetic acid enhanced chromoendoscopy. Severe whitening and delayed fading in acetic acid-enhanced endoscopy were observed and pathological biopsy was performed to determine the effectiveness of severe whitening and delayed fading under acetic acid-enhanced endoscopy for diagnosing gastric intestinal metaplasia. Results Ninety-one patients successfully completed the study protocol. Tissues in a total of 202 sites were included in the biopsy, and those in 99 sites were confirmed to be GIM by histopathology. In terms of severe whitening, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the diagnosis was 87.9%, 90.3%, 89.7%, 88.6% and 89.1%, respectively. Delayed fading is sensitive to diagnosis and the specificity, specificity, positive predictive value, negative predictive value and accuracy was 88.9%, 87.4%, 87.1%, 89.1%, and 88.1%, respectively. For conventional white light endoscopy, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the diagnosis of gastric intestinal metaplasia was 41.4%, 90.3%, 80.4% and 61.6%, 66.3%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of acetic acid chromoendoscopy for the diagnosis of gastric intestinal metaplasia was 88.9%, 94.2%, 91.7%, 91.5%, and 91.6%, respectively. The sensitivity and accuracy of acetic acid chromoendoscopy were significantly higher than that of standard white light endoscopy for the diagnosis of gastric intestinal metaplasia(all P<0.05). Conclusion Acetic acid chromoendoscopy with severe whitening and delayed fading is a simple, feasible, highly sensitive and accurate method for the diagnosis of gastric intestinal metaplasia, which is worthy of clinical promotion.