内镜智能分光比色放大结肠镜在早期大肠癌及其癌前病变诊断中的应用

目的探讨内镜智能分光比色(fuji intelligent chromo endoscopy,FICE)放大结肠镜在早期大肠癌及其癌前病变诊断中的应用价值。方法选择2010年1-12月在中国人民解放军第184医院行结肠镜检查发现大肠新生物及息肉样病变的患者101例,采用FICE放大结肠镜对病变进行腺管开口分型及毛细血管形态分型,同时取组织行病理组织学检查。结果 101例患者共发现大肠新生性病变152个。病理检查诊断为:非肿瘤性病变45个,肿瘤性病变107个。FICE放大结肠镜对肿瘤性病变的诊断符合率、敏感性、特异性分别为:93.4%(142/152)、85.7%(42/49)、97.1%(100/103)。结论 FICE放大结肠镜可以观察病变黏膜表层微细结构及毛细血管的形态,对大肠肿瘤性病变诊断符合率高,具有良好的临床应用价值。

染色结肠镜和染色放大结肠镜在结直肠隆起性黏膜病变中临床应用价值的研究

目的探讨普通结肠镜、染色结肠镜、染色放大结肠镜在结直肠隆起性黏膜病变中临床应用价值。方法对30例结肠镜检查发现黏膜隆起性病变的病人,先作普通结肠镜诊断,再作染色结肠镜诊断,最后用放大结肠镜作出诊断。所有病变作病理学检查。将普通结肠镜、染色结肠镜、染色放大结肠镜的诊断结果与病理学诊断结果进行比较分析。结果共发现64个隆起性黏膜病变,普通结肠镜诊断为炎性息肉、管状腺瘤、绒毛状腺瘤、结直肠癌与病理诊断的符合率分别为68.8%、76.9%、66.7%和80%,总病理符合率为73.4%;染色结肠镜分别为86.7%、87.5%、85.7%和90.9%,总病理符合率为87.5%;染色放大结肠镜分别为93.3%、91.7%、92.9%和90.9%,总病理符合率为92.2%。结论普通结肠镜不能有效鉴别结直肠隆起性黏膜瘤性与非瘤性的改变,需要依赖病理组织学判断性质。染色结肠镜与染色放大结肠镜均能有效提高对结直肠隆起性黏膜瘤性与非瘤性病变的鉴别能力,具有较高的临床应用价值。染色结肠镜应列为常规检查以提高早期结肠肿瘤的检出率。

变焦放大结肠镜联合靛胭脂染色常规检查末端回肠的价值

目的:了解常规回肠末端检查的重要性,提高末端回肠病变的检出率和正确诊断率。方法:用变焦放大电子结肠镜联合喷洒靛胭脂染色对282例回肠末端行常规形态观察及组织学研究。结果:经放大结肠镜局部喷洒靛胭脂检出67例末端回肠病变。结论:用放大电子结肠镜联合靛胭脂染色常规检查回肠末端黏膜,可提高末端回肠病变的检出率,减少漏出率,特别对微小病变的检出更有价值。

放大色素结肠镜识别直肠异常隐窝病灶的可靠性及准确性

目的系统评估放大色素结肠镜(MCE)判断直肠异常隐窝病灶(ACF),尤其是伴异型增生ACF的可靠性及准确性。方法将内镜识别的ACF与活检病理学结果做对照研究,预测经病理学结果证实的内镜下伴异型增生ACF的可靠性。结果 MCE识别病理性伴异型增生ACF病变的正确百分率为88.1%,灵敏度为81.8%,特异度为89.0%。结论 MCE对判断结直肠ACF病变有较高的病理符合率,接近病理诊断,可避免过度活检,具有较高临床应用价值。

Magnifying chromoscopy, a novel and useful technique for colonoscopy in ulcerative colitis

Ulcerative colitis (UC) is a chronic inflammatory bowel disorder characterized by exacerbations and remissions. The degree of inflammation as assessed by conventional colonoscopy is a reliable parameter of disease activity. However, even when conventional colonoscopy suggests remission and normal mucosal findings, microscopic abnormalities may persist, and relapse may occur later. Patients with long-standing, extensive ulcerative colitis have an increased risk of developing colorectal cancer. Ulcerative colitis-associated colorectal cancer is characterized by an early age at onset, poorly differentiated tumor cells, mucinous carcinoma, and multiple lesions. Early detection of dysplasia and colitic cancer is thus a prerequisite for survival. A relatively new method, magnifying chromoscopy, is thought to be useful for the early detection and diagnosis of dysplasia and colitic cancer, as well as the prediction of relapse.

Evaluation of magnifying colonoscopy in the diagnosis of serrated polyps

AIM:To elucidate the colonoscopic features of serrated lesions of the colorectum using magnifying colonoscopy.METHODS:Broad division of serrated lesions of the colorectum into hyperplastic polyps(HPs),traditional serrated adenomas(TSAs),and sessile serrated adenomas/polyps(SSA/Ps) has been proposed on the basis of recent molecular biological studies.However,few reports have examined the colonoscopic features of these divisions,including magnified colonoscopic findings.This study examined 118 lesions excised in our hospital as suspected serrated lesions after magnified observation between January 2008 and September 2011.Patient characteristics(sex,age),conventional colonoscopic findings(location,size,morphology,color,mucin) and magnified colonoscopic findings(pit pattern diagnosis) were interpreted by five colonoscopists with experience in over 1000 colonoscopies,and were compared with histopathological diagnoses.The pit patterns were categorized according to Kudo's classification,but a more detailed investigation was also performed using the subclassification [type Ⅱ-Open(type Ⅱ-O),type Ⅱ-Long(type Ⅱ-L),or type Ⅳ-Serrated(type Ⅳ-S)] proposed by Kimura T and Yamano H.RESULTS:Lesions comprised 23 HPs(23/118:19.5%),39 TSAs(39/118:33.1%:with cancer in one case),50 SSA/Ps(50/118:42.4%:complicated with cancer in three cases),and six others(6/118:5.1%).We excluded six others,including three regular adenomas,one hamartoma,one inflammatory polyp,and one juvenile polyp for further analysis.Conventional colonoscopy showed that SSA/Ps were characterized as larger in diameter than TSAs and HPs(SSA/P vs HP,13.62 ± 8.62 mm vs 7.74 ± 3.24 mm,P < 0.001;SSA/Ps vs TSA,13.62 ± 8.62 mm vs 9.89 ± 5.73 mm,P < 0.01);common in the right side of the colon [HPs,30.4%(7/23):TSAs,20.5%(8/39):SSA/P,84.0%(42/50),P < 0.001];flat-elevated lesion [HPs,30.4%(7/23):TSAs,5.1%(2/39):SSA/Ps,90.0%(45/50),P < 0.001];normal-colored or pale imucosa [HPs,34.8%(8/23):TSAs,10.3%(4/39):SSA/Ps,80%(40/50),P < 0.001];and with large amounts of mucin [HPs,21.7%(5/23):TSAs,17.9%(7/39):SSA/Ps,72.0%(36/50),P < 0.001].In magnified colonoscopic findings,17 lesions showed either type Ⅱ pit pattern alone or partial type Ⅱ pit pattern as the basic architecture,with 14 HPs(14/17,70.0%) and 3 SSA/Ps.Magnified colonoscopy showed the type Ⅱ-O pit pattern as characteristic of SSA/Ps [sensitivity 83.7%(41/49),specificity 85.7%(54/63)].Cancer was also present in three lesions,in all of which a type Ⅵ pit pattern was also present within the same lesion.There were four HPs and four TSAs each.The type Ⅳ-S pit pattern was characteristic of TSAs [sensitivity 96.7%(30/31),specificity 89.9%(72/81)].Cancer was present in one lesion,in which a type Ⅵ pit pattern was also present within the same lesion.In our study,serrated lesions of the colorectum also possessed the features described in previous reports of conventional colonoscopic findings.The pit pattern diagnosis using magnifying colonoscopy,particularly magnified colonoscopic findings using subclassifications of surface architecture,reflected the pathological characteristics of SSA/Ps and TSAs,and will be useful for colonoscopic diagnosis.CONCLUSION:We suggest that this system could be a good diagnostic tool for SSA/Ps using magnifying colonoscopy.

Lobulated inflammatory myoglandular polyp in the ascending colon observed by magnifying endoscopy and treated with endoscopic polypectomy

The patient was a 33-year-old man with hematochezia. Colonoscopy revealed a Iobulated peduncular polyp with bleeding, about 40 mm in diameter, in the ascending colon. The polyp had both red and white components and a mosaic pattern. Magnifying observation revealed a red rugged surface component, and smooth white nodules with enlarged round or oval crypt openings. Endoscopic polypectomy was performed. Histological examination of the specimen revealed inflammatory granulation tissue in the lamina propria, proliferation of smooth muscle, and hyperplastic glands with cystic change. This polyp was diagnosed as inflammatory myoglandular polyp （IMGP）. Lobulated-type IMGP in the ascending colon is rare.