胃镜精检在首次胃镜提示胃癌前病变中的应用价值*

Clinical value of intensive endoscopic examination for gastric precancerouslesion diagnosed by first endoscopic examination*

摘要:

目的??探讨联合应用放大内镜、染色内镜、窄带成像（NBI）及高频超声微探头对首次胃镜提示胃癌前病变的患者进行再次胃镜精检的价值。方法?2014年6月-2015年7月，对该科首次胃镜病理发现胃低级别上皮内瘤变（LGIN）、高级别上皮内瘤变（HGIN）的患者进行电话召回，应用放大内镜、染色内镜和NBI等进行胃镜精检，发现有可疑病灶时进行高频超声微探头检查以判断浸润深度。萎缩性胃炎及肠化但未合并上皮内瘤变的患者未纳入本研究。共65例符合上述标准的患者入选，初次胃镜提示LGIN 56例、HGIN 9例。结果?65例患者最终证实胃癌14例，首诊为LGIN 7例，HGIN 7例。14例胃癌患者中9例于该院治疗[5例行内镜黏膜下剥离术（ESD）、4例手术]，其中早期胃癌8例（6例黏膜内癌、2例浸润黏膜下层），1例进展期癌（浸润至浅肌层），另5例均呈早癌内镜表现，但因拒绝于该院治疗，无法确诊分期。结论?胃镜检查发现上皮内瘤变时，往往提示存在早期癌变的可能，对该类患者进行有针对性的胃镜精检有助于发现之前遗漏的早癌病灶，避免漏诊。

Abstract:

Objective?To evaluate the role of intensive endoscopic examination with magnifing endoscopy, chromendoscopy, narrow band imaging (NBI) and high-frequency mini-probe sonography (HFMPS) for gastric precancerous lesion diagnosed by first endoscopic examination.?Methods?From June 2014 to July 2015, patients diagnosed with low grade intraepithelial neoplasia (LGIN) and high grade intraepithelial neoplasia (HGIN) in stomach were called back and suggested for intensive endoscopic examination with magnifing endoscopy, chromoendoscopy, and NBI. A HFMPS was conducted to evaluate the invasive depth when a suspected lesion was confirmed. Atrophic gastritis and intestinal metaplasia without intraepithelial neoplasia were excluded from this study. A total of 65 patients with LGIN (56 cases) or HGIN (9 cases) were called back and an intensive endoscopic examination was performed. ?Results?14 of 65 patients were confirmed as gastric cancer by intensive endoscopic examination (diagnosed as LGIN in 7 cases and HGIN in 7 previously). 9 cases were treated in our hospital (endoscopic submucosal dissection for 5 cases and surgery for 4). 8 early cancers were confirmed with 6 intramucosal and 2 submucosal invasive lesions. Only 1 progressed cancer invasive to superficial muscularis propria was diagnosed. Other 5 cases who refused treatment in our hospital were highly suspected for early cancer based on the endoscopic and HFMPS examination.?Conclusion?An early cancer may exist already when intraepithelial neoplasia was found by previous endoscopic biopsy. Intensive endoscopic examination for this condition is very useful to avoid misdiagnosis.