窄带成像放大内镜在Barrett食管随访监测中的应用价值  

The value of NBI,ME for targeting biopsy in the follow-up of Barrett esophagus

作　　者：王芳军[1] 高昳 赵可[2] 汪娟[2] 刘华敏[1] 刘鹏飞[1] Wang Fangjun Gao Yi Zhao Ke Wang Juan Liu Huamin Liu Pengfei(Department of Gastroenterology, The Affiliated Jiangyin Hospital of Southeast University Medical School, Jiangyin 214400, China)

机构地区：[1]东南大学医学院附属江阴医院消化内科,江苏省江阴市214400 [2]东南大学医学院附属江阴医院病理科,江苏省江阴市214400

出　　处：《中华消化内镜杂志》2016年第11期764-768,共5页Chinese Journal of Digestive Endoscopy

基　　金：无锡市卫生局重大科研项目（Z201509）

摘　　要：目的评价在Barrett食管的随访监测中应用窄带成像放大内镜（NBI—ME）指导靶向活检的价值。方法2012年9月至2015年5月，96例病理诊断为Barrett食管的患者，采用配对交叉设计，通过计算机软件随机决定先行白光内镜（WLI）的四象限活检（wu组）或NBI—ME的靶向活检（NBI—ME组），1—3个月后换另一种方法观察及活检，对比分析两种模式下的活检情况。结果有88例完成整个研究，最终病理结果显示4例无特殊的肠上皮化生（SIM）、55例为SIM、23例为低级别上皮内瘤变、6例为高级别上皮内瘤变。WLI组平均每例取活检数量明显多于NBI．ME组（5．3块比3．1块，P〈0．05），上皮内瘤变检出率明显低于NBI—ME组[21．6％（19／88）比31．8％（28／88），P〈O．05]，上皮内瘤变诊断准确率亦明显低于NBI—ME组[58．6％（17／29）比93．1％（27／29），P〈0．05]。结论在Barrett食管的随访监测中，NBI—ME指导靶向活检的临床价值较高。相比WLI的四象限活检，更易发现上皮内瘤变及准确分级，并且所需活检数量更少。Objective To assess the value of NBI-ME for targeting biopsy in the follow-up of Barrett esophagus. Methods A total of 96 patients with Barrett esophagus were enrolled and biopsied between Sep- tember 2012 and May 2015. With paired crossover design, the patients were randomly allocated to receive a WLI or NBI-ME, who received the other examination in 1-3 months. Outcomes of NBI-ME and WLI were compared with histology of biopsy specimen, and the biopsy quantities were also compared. Results A total of 88 patients completed the study, 4 cases with non-specialized intestinal metaplasia,55 cases with special- ized intestinal metaplasia （SIM） ,23 cases with low grade intraepithelial neoplasia（LGIN） and 6 cases with high grade intraepithelial neoplasia（HGIN） were detected. The biopsy number of WLI group was higher than that of NBI-ME group（ 5.3 VS 3.1 ,P〈0.05）.The incidence of intraepithelial neoplasia of WLI was lower than that of NBI-ME [ 21.6% （19/88） VS 31.8% （ 28/88）, P〈 0. 05 ]. Diagnostic accuracy of WLI was lower than that of NBI-ME[ 58. 6% （17/26） VS 93.1%（27/29） ,P〈0. 05） ]. Conclusion NBI-ME can detect more lesions of intraepithelial neoplasia than WLI in the follow-up of Barrett esophagus, and fewer biopsy specimens are needed.

关 键 词：BARRETT食管 内窥镜检查 随访研究 窄带成像 

分 类 号：R571[医药卫生—消化系统]