New generation videoendoscopes potentially may visualize duodenal villi. This study compared endoscopic findings with this type of instrument to the histopathologic evaluation of duodenal villi. A total of 191 patient...New generation videoendoscopes potentially may visualize duodenal villi. This study compared endoscopic findings with this type of instrument to the histopathologic evaluation of duodenal villi. A total of 191 patients underwent upper end oscopy for the purpose of obtaining duodenal biopsy specimens. The findings were assessed independently by 3 experienced observers by using a commercially avail able, high-resolution, high-magnifying (×2) videoendoscope. The duodenal villous profile was determined by endoscopic magnification and by endoscopic magnifi cation after filling the duodenum with water. With both endoscopic magnification and endoscopic magnification after filling the duodenum with water, villous pat terns were scored as the following: definitely present, partially present, or de finitely absent. Villous patterns also were histopathologically scored as the fo llowing: normal, partial villous pattern, or total villous atrophy. Interobserver variability was excellent (κ= 0.93). The concordance between either endoscopic magnification or endoscopic magnification after filling the duodenum with water and histology was 100% for presence/absence of villi. The sensitivity, the specificity, and the positive and negative predictive values of endoscopic magnification for detection of any villous abnormality were 95%, 99%, 95%, and 99%, respectively; the respective values of endoscopic magnification after filling the duodenum with water were 95%, 98%, 92%, and 99%. High-resolution magnifying upper endoscopy can reliably predict the presence or the absence of duodenal villi.展开更多
Background: We assessed the usefulness of acetic acid-enhanced magnifying endoscopy in the diagnosis of gastric neoplasia. Methods: Forty-five patients (27 men, 18 women; median age 61.6 years)with gastric carcinoma o...Background: We assessed the usefulness of acetic acid-enhanced magnifying endoscopy in the diagnosis of gastric neoplasia. Methods: Forty-five patients (27 men, 18 women; median age 61.6 years)with gastric carcinoma or adenomawere enrolled in a prospective trial of enhanced magnifying endoscopy after instillation of 1.5%acetic acid. Acetic acid-enhanced magnified views of carcinoma or adenoma and the surrounding non-neoplastic mucosa were observed, and the duration of whitening time of each lesion was recorded. Observations: Magnified views of carcinoma showed a minute, grain-like pattern that differed from the surrounding noncancerous mucosa. The histopathologic diagnostic criteria were based on the Vienna classification of GI epithelial neoplasia. The mean duration of whitening differed with each histologic type: low-grade adenoma,94 seconds; high-grade adenoma,24.3 seconds; noninvasive carcinoma, 20.1 seconds; invasive intramucosal carcinoma, 3.5 seconds; and submucosal carcinoma or beyond, 2.5 seconds. The dura tion in the non-neoplastic surrounding mucosa was 90 seconds. After the disappe arance of whitening in the carcinoma, the irregular pattern of the carcinoma rea ppeared, and the contrast between carcinomatous microvessels and the whitened no n-neoplastic tissue became very clear on magnifying endoscopy. In accordance wi th the duration of whitening, more than 1 minute was termed “continuous whiteni ng," from 31 to 60 seconds was “delayed disappearance of whitening," from 30 to 6 seconds was “early disappearance of whitening," and 0 to 5 seconds was “no response." Conclusions: Acetic acidenhanced magnifying endoscopy was useful for the diagnosis of gastric adenocar cinoma. The duration of whitening differed among grades of neoplasia, and it was possible to observe changes in the whitening with time. Acetic acid-enhanced magnifying endoscopy, therefore, can be termed “dynamic chemical magnifying endo scopy."展开更多
文摘New generation videoendoscopes potentially may visualize duodenal villi. This study compared endoscopic findings with this type of instrument to the histopathologic evaluation of duodenal villi. A total of 191 patients underwent upper end oscopy for the purpose of obtaining duodenal biopsy specimens. The findings were assessed independently by 3 experienced observers by using a commercially avail able, high-resolution, high-magnifying (×2) videoendoscope. The duodenal villous profile was determined by endoscopic magnification and by endoscopic magnifi cation after filling the duodenum with water. With both endoscopic magnification and endoscopic magnification after filling the duodenum with water, villous pat terns were scored as the following: definitely present, partially present, or de finitely absent. Villous patterns also were histopathologically scored as the fo llowing: normal, partial villous pattern, or total villous atrophy. Interobserver variability was excellent (κ= 0.93). The concordance between either endoscopic magnification or endoscopic magnification after filling the duodenum with water and histology was 100% for presence/absence of villi. The sensitivity, the specificity, and the positive and negative predictive values of endoscopic magnification for detection of any villous abnormality were 95%, 99%, 95%, and 99%, respectively; the respective values of endoscopic magnification after filling the duodenum with water were 95%, 98%, 92%, and 99%. High-resolution magnifying upper endoscopy can reliably predict the presence or the absence of duodenal villi.
文摘Background: We assessed the usefulness of acetic acid-enhanced magnifying endoscopy in the diagnosis of gastric neoplasia. Methods: Forty-five patients (27 men, 18 women; median age 61.6 years)with gastric carcinoma or adenomawere enrolled in a prospective trial of enhanced magnifying endoscopy after instillation of 1.5%acetic acid. Acetic acid-enhanced magnified views of carcinoma or adenoma and the surrounding non-neoplastic mucosa were observed, and the duration of whitening time of each lesion was recorded. Observations: Magnified views of carcinoma showed a minute, grain-like pattern that differed from the surrounding noncancerous mucosa. The histopathologic diagnostic criteria were based on the Vienna classification of GI epithelial neoplasia. The mean duration of whitening differed with each histologic type: low-grade adenoma,94 seconds; high-grade adenoma,24.3 seconds; noninvasive carcinoma, 20.1 seconds; invasive intramucosal carcinoma, 3.5 seconds; and submucosal carcinoma or beyond, 2.5 seconds. The dura tion in the non-neoplastic surrounding mucosa was 90 seconds. After the disappe arance of whitening in the carcinoma, the irregular pattern of the carcinoma rea ppeared, and the contrast between carcinomatous microvessels and the whitened no n-neoplastic tissue became very clear on magnifying endoscopy. In accordance wi th the duration of whitening, more than 1 minute was termed “continuous whiteni ng," from 31 to 60 seconds was “delayed disappearance of whitening," from 30 to 6 seconds was “early disappearance of whitening," and 0 to 5 seconds was “no response." Conclusions: Acetic acidenhanced magnifying endoscopy was useful for the diagnosis of gastric adenocar cinoma. The duration of whitening differed among grades of neoplasia, and it was possible to observe changes in the whitening with time. Acetic acid-enhanced magnifying endoscopy, therefore, can be termed “dynamic chemical magnifying endo scopy."
