Endoscopy diagnosis of intestinal epithelial

Becausestomach canceraround the existence of intestinal epithelial, therefore, intestinal epithelial is stomach cancer, especially as the occurrence of differentiated gastric cancer, from the 1950s began to attract much attentionLong-term cohort studies in recent years have also shown that the incidence of stomach cancer in the background mucosa with intestinal epithelial sepia in the background mucosa is significantly higher in theof helicobacter pylori (Hp)infection sepsis (1.7 to 6.4 times)The intestinal epithelial in the stomach is closely related to the occurrence of stomach cancerIntestinal epithelial sacintifying is the main cause of differentiated gastric cancer, most canceris is produced by the stomach inherent mucosa that is prone to intestinal epithelial, and some differentiated stomach cancer may be produced by the intestinal epithelial bioscosisIn recent years, with the continuous development and perfection of endoscopy technology, especially the application of image-enhanced endoscopy, the detection rate of intestinal epithelial sacinhas has been significantly improved, providing a strong guarantee for the early detection of disease, earlydiagnosisand early treatmentthe visual microscope to observe the visual form of intestinal epithelialthe visual form of intestinal epithelial, for the use of endoscopy to diagnose the lesions is very importantIn 1971, Jijing, through the visual microscope of surgical specimens, studied in detail the relationship between the visual form and organizational structure of intestinal epithelials, and divided the visual type of the intestinal epithelial izedofe into special type, decay type, line and branch type, map type, diffuse typeIn addition, according to the relationship with the gastric community, intestinal epithelial seispha is divided into gastric cell type, in the gastric cell between the groove type, and the gastric community has no relationship to produce irregular typeMoreover, according to the bump change of the biogastric gastric cell, it is divided into bulge type (Figure 1), flat type (Figure 2), and depression type (Figure 3) Moreover, according to the dyed body vision microscope observation, the micro-surface structure of the gastric mucosa is roughly divided into gastric concave and gastric groove structure, in general, the body presents a small concave structure of the stomach, the stomach sinus presents the gastric groove structure, if there is chronic gastritis, the gastric small concave type has the tendency to change the structure of the gastric groove In addition, the intestinal epithelial biopsy mucosa is mostly gastric groove structure, especially compared with the surrounding non-chemical biostick inglime membrane, large brain back,mesh gastric groove structure, or show similar to the small intestine mucous membrane fluff structure Figure 1 Uplifted intestinal epithelial life at the stomach sinuses A: Regular endoscopy, bulge with more white tones in the stomach sinuses B: NBI observes the bulge of the white tone becomes clearer C, D: When zooming in on the boundary of the bulge, the white part found LBC on the surface of the field-like epithelial, and because of the WOS in the inter-den, the tea-colored epithelial capillaries blood vessels blurred In addition, the epithelial at the edge of the adengling nest is white turbid (Marginal Turbid Band) compared to the non-chemical mucous membrane Figure 2 Flat intestinal epithelial sins with large bends in the sinuses of the stomach A: The general endoscopic observation lacks bumps and tonal changes, the lesions are not obvious B: After spraying 0.1% of the melanocyl, the colored intestinal epithelial became obvious C: Zoom in on the coloring department to see the surface structure of field-like fluff D: NBI zooms in and sees the LBC corresponding to the brushed edge, consistent with the absorption of the epithelial of the coloration figure 3 of the lower body of the small bend of the sunken intestinal epithelial A: A small bend in the lower part of the stomach body found redness of the concave lesions B: The shape and hue of the indigo dyeing depression are obvious C: The NBI in the recessed part amplified to observe a neat gastric dent The opening of the glandal nest in the recess is different from the positive circle of the normal gastric underside gland, is a star type, and LBC is visible in the opening of the gland.i conventional endoscopy diagnosis , long ago through endoscopy to the concept of histological disease intestinal epithelial diagnosis attempt In 1968, Takemoto and others used fiber mirrors from the stomach sinuses scattered in the gray-white flat bulge for biopsy, found intestinal epithelial, so this is considered to be the specific observation of intestinal epithelial, named special type of intestinal epithelial After that, Kaminishi et al conducted a multi-center randomized control study of the diagnosis of intestinal epithelial syllitas were evaluated, although the specificity is high (the body small bend 98%, the stomach sinus bend 100%), but the sensitivity is significantly reduced (small bend of the body 6%, the stomach sinus bend 13%), it can be concluded that ulcerative gastritis should be excluded from the endoscopy classification of gastritis This is not only because of the bulge of the intestinal epithelial, mostly flat, lack of bumps and tonal changes (Figure 2a), so it is difficult to diagnose only conventional endoscopy but the recent multi-center randomized controlled study using high-resolution electron endoscopes, not only based on white-toned mucous membranes, but also based on fluff-like appearance, surface roughness and other observations based on diagnosis, even if the conventional endoscopy observation, the diagnosis of intestinal epithelial seroinized, sensitivity of 86% in small bends, 66% of specificity, there are reports that small gastric sinuses of sensitivity of 95%, specialdegree sitter s69% In addition, in the case of Hp eludes, the diagnostic sensitivity of erythema to intestinal epithelial sepsis was 73% and the specificity was 84% (Figure 3a) The diagnostic ability of conventional endoscopy can be improved by a new interpretation of the results of high-resolution electron endoscopy and endoscopic endoscopy pigment endoscopy diagnostic 1970s, as an endoscopy of intestinal epithelial, one of the most diagnosed methods of the use of the pigment endoscope (sensitivity 93%, specific ity 85%) In this method, the intestinal epithelial biomium with absorption ability absorbs pigment and is colored (Figure 2b, c) In addition, Dinis-Ribeiro and others in the armored blue endoscope and with amplification observation, studied the surface fine structure, intestinal epithelial diagnostic sensitivity of 76%, special degree of 87%, colored circular-short-line adenoid opening mucosa for the full type of intestinal epithelial, there are reports that the surface structure of the mucous membrane has a larger tendency to have intestinal upper skin The diagnosis ability of the melanocytosis endoscope is very good, but the configuration of reagents, removal of mucus and time-consuming, and DNA damage caused by the photoreaction after dyeing limit semostly limited in clinical application Wuzhi and others used the sesame method to study the stomach cell like with the change of chronic gastritis, with the expansion of atrophic gastritis, the multi-angled gastric cell (F1 type) became smaller, became flat (F3), intestinal epithelial life is more common in the small but not plastic F3 type gastric cell image The recent multi-center randomized controlled study, in addition to the observation results of the gastric cell image, based on the appearance of fluff-like, white mucous membrane, mucous membrane surface rough, etc., the seodia method of the diagnosis of intestinal epithelial seisido (body: sensitivity 86%, special degree 83%, stomach sinus: sensitivity 78%, special degree 58%) The diagnosis ability of the body and the stomach sinuses is different, which also indicates that there are differences in the form and distribution of intestinal epithelial sins caused by various parts autofluorocosic endoscope (AFI) AFI is a blue excitation light from the endoscope to capture autologous fluorescence produced by the mucous membrane Using this device to observe the gastric mucosa, no atrophy and intestinal epithelial body mucosa is purple-dark green, there is atrophy and intestinal epithelial mucous membrane into a bright green (Figure 4b) Inoue et al actually carried out biopsies from various tonal regions, in the purple region almost no intestinal epithelial, but compared with the purple region, the intestinal epithelial disease was obvious, the diagnosis of the intestinal epithelial population in the green area of the body was 77% sensitivity, the specificity was 75% AFI treats the atrophy mucosa area of intestinal epithelial sacs as a green area, but the diagnostic ability may decrease slightly due to the dispersion of intestinal epithelial splies in the multi-nest NBI Magnify ingenuation endoscope NBI is a device that is depicted by changing the light to a short wavelength of narrow-band light, emphasizing the surface structure of the mucous membrane surface and the construction of blood vessels In this method and with the expanded endoscope observation, it is possible to observe in detail the microsurface structure and microvascular structure corresponding to tissue image In conventional endoscopy, the intestinal epithelial is slightly whiter In the non-amplification of NBI observations, intestinal epithelial sepia was clearly seen as a cyan-white spot-like area (Figure 1b) Because of the absorption capacity of the intestinal epithelial, the deposition of fat droplets was found under the epithelial, and the inter-nest WOS was observed with NBI, so that the tea-colored epithelial capillaries were not ambiguous (Figure 1c, d) In addition, lbC was found on the surface of intestinal epithelial, presumably due to the reflection of short wavelength light on the brushed edge LBC has good diagnostic ability (sensitivity 89%, sensitivity 89%) for intestinal epithelial seishese There are reports of a special ity of 93 per cent In addition, An et al reported that the epithelial on the edge of the adenoid sein in the intestinal epithelial skin looked white turbid (Marginal turbid band, MTB) (Figure 1c, d) Other, especially in the body, non-shrinking mucosa shows the structure of the epithelial capillaries surrounding the opening of the gland son, the presence of the atrophy mucosa of the upper skin became by the stomach sinuses similar to the gastric groove division of the field ridge or granular epithelial in the epithelial capillaries surrounded by the pattern, can be considered, compared with non-shrinking mucosa, the unit area of blood vessel density is low Above, WOS and the resulting uncertainty of the epithelial capillaries, the reflection of short wavelength light caused by LBC, the epithelial white turbidity caused by MTB, the difference of the surface structure of the epithelial skin, etc., is the main reason for the intestinal epithelial and dechemical mucosa compared to the white ness, it can be thought that The NBI will emphasize these observations more Kanzaki and others according to the relationship between epithelial and vascular vessels, the micro-fine mucosa structure of the gastric body of the caricopic endoscope and NBI amplification endoscope is roughly divided into small concave types of subcutaneous capillaries surrounding the opening of the adenarium and the groove type of epidermis surrounding the epithelial capillaries at the edge of the adenoid nest, in the case of Hp-positive gastritis, from the micro-gastritis gastritis cell structure and organizational structure associated with the micro-nebristal gastritis In the narrow cases of atrophic gastritis, only in the small gastric compartment found nest-like small groove-shaped mucosa, but with the expansion of atrophic gastritis, groove-type mucous membrane in the gastric small area expanded, in a wide range of cases of atrophic gastritis, the body mucosa is mostly occupied by the groove-type mucosido In the stomach body, the stomach area is almost all groove type, the stomach small interval groove shows the surface structure of the groove type (Figure 4e, f) in addition, according to the target biopsy report, groove-type mucous membrane compared with small concave mucosa, heliose atrophy, intestinal epithelial growth is significantly higher The polycentritus, nest-like occurrence and progressive form of the groove-type mucosis of the stomach can be considered to be consistent with the concept of multi-lesionaa gastritis reported by Correa Shinzaki et al have also studied the association between the expansion of atrophic gastritis and the fine surface structure of the stomach sinuses, which is basically a ridge-like surface structure, but the report shows that with the expansion of atrophic gastritis, there is a tendency of increased growth of fluffy-like white mucosias in the gastritis area The gastric sinuses do not widen, the fluffy mucous membrane sexist in the center of the gastric cell (Figure 5), or the gastric cell or irregularpresence in the region (Figure 6), indicating that the progression of intestinal epithelial strains may be different from the body the distribution of intestinal epithelial sacs (gastric groove type) in the stomach body A: Small bends in the stomach body are accompanied by a dedying mucosa with blood vessels B: The department was found in AFI as a green area, with purple areas in a mosaic-like mix c: Dark brown and blue-white areas in NBI are a mosaic-like mix D:0.2% of the carnine dyed mosaic-like area is: it can be seen that pigment deposits in the stomach cell, is composed of a wide gastric small trench that looks like a blue tone E: Zoom in to see the stomach cell because it is a small stomach concave structure, pigment is difficult to deposit on the surface, because the gastric small interval ditch is the gastric trench structure, so deposit pigment F: Through NBI amplification observation, in the stomach cell found in the stomach cell is the same as the non-shrinking gastric bottom gland mucous membrane network surrounded by the circular adenoid nest opening, in the gastric small interval ditch found with LBC-like field-like fluff-like surface structure figure 5 Distribution of intestinal epithelial sinuses (gastric cell type) A, B: The stomach corner of the same case as the one above 0.2% of the indigo dyeing area is divided by narrow gastric small interval grooves C, D: Pigment-NBI Amplification Observations found that the center of the stomach cell has a fluffy-like surface structure that accompanies LBC Figure 6 Distribution of intestinal epithelial sinuses (irregular type) in the stomach sinuses A: Red and white mucous membranes found in large bends in the stomach sinuses are mosaic-like B: NBI observed that the red mucous membrane appeared dark brown, and the white mucous membrane was more clearly observed C, D:0.2% indigo dyeing is mainly the area of red tone is a narrow gastric small interval ditch division of the stomach cell, white area is not related to the stomach cell, by the regional distribution of pigment deposition, looks like the blue tone of the area E, F: Zoom in and see that the area where the pigment is difficult to deposition is the area with a field-like surface structure, and the area of pigment deposition is the area with a slightly white tonal fluff surface structure concluded it is important to intestinal epithelial as a high-risk lesion of stomach cancer The micro-fine surface structure of the gastric mucosa shows the small concave structure of the stomach in the stomach body, the gastric groove structure is shown in the stomach sinuses, and the micro-surface structure of the intestinal epidermis shows the gastric groove structure similar to the claustrophobic gland, or the fluff-like form similar to the small intestine Regular observation and NBI show that the intestinal epithelial is more white than the nonchemical mucosa, and in NBI amplification observation, the characteristic observation results corresponding to the absorption capacity of LBC and WOS can be observed more clearly Endoscopy can grasp the local presence and distribution of intestinal epithelial, can be carried out under the endoscope of the targeted biopsy shared the image F 23, suffering from upper abdominal discomfort for one year white light endoscope: gastric sinus polyps white light endoscope: gastrointestinal polyps white light endoscope: gastrointestinal polyps white light endoscope: gastrointestinal polyps white light endoscope: gastric body, bottom, fengo polyps white light endoscope:
com0707 Source: