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目的探讨Barrett食管在增强放大内镜及普通内镜下与组织病理学的一致性,揭示增强放大内镜在诊断Barrett食管的优势。方法将2007年5月至2009年1月武汉大学人民医院消化内科诊治的609例食管病变患者分为普通内镜组和增强放大内镜组。普通内镜组在胃食管结合处近端病变处取活检组织;增强放大内镜组根据内镜下黏膜像的不同取活检,两组进行内镜与组织病理学比较及分析。结果142例Barrett食管患者中,增强放大内镜组84例,普通内镜组58例,增强放大内镜组的敏感度、特异度、误差率、漏诊率分别为90.5%、97.5%、2.5%、9.5%,普通内镜组分别为55.2%、60.5%、39.5%、44.8%,两组比较敏感度及特异度的差异有统计学意义(P<0.01);增强放大内镜下的脑回绒毛型其病理类型均为肠化生上皮,与小圆型和网格型比较,差异有统计学意义(P<0.01)。结论增强放大内镜在Barrett食管的诊断和组织病理学上较普通内镜有更好的一致性,且增强放大内镜有助于Barrett食管肠化生上皮的检查,对Barrett食管的临床随访有重要意义。
Objective To investigate the consistency of Barrett’s esophagus with histopathology under magnifying endoscopy and endoscopy and to reveal the advantages of enhanced magnifying endoscopy in the diagnosis of Barrett’s esophagus. Methods From May 2007 to January 2009, 609 patients with esophageal disease diagnosed and treated in Department of Gastroenterology, People’s Hospital of Wuhan University were divided into two groups: general endoscopic group and enhanced endoscopic group. The biopsy tissues were taken from the proximal endoscopic group at the junction of gastroesophageal junction and the endoscopic lesion at the gastroesophageal junction. The biopsy was performed according to the different endoscopic mucosal biopsies. The endoscopic and histopathological changes were compared and analyzed between the two groups. Results Among 142 patients with Barrett ’s esophagus, 84 cases were enlarged magnifying endoscopy group and 58 cases were general endoscopy group. The sensitivity, specificity, error rate and missed diagnosis rate of magnifying endoscopy group were 90.5%, 97.5%, 2.5% , 9.5% respectively, and the average endoscopy group was 55.2%, 60.5%, 39.5% and 44.8% respectively. There was significant difference between the two groups in the sensitivity and specificity (P <0.01) The pathological types of villi were intestinal metaplasia, with the small round and the grid type, the difference was statistically significant (P <0.01). Conclusions Enhanced magnifying endoscopy has better consistency than ordinary endoscopy in the diagnosis and histopathology of Barrett ’s esophagus. Enhancing magnifying endoscopy is helpful for the examination of Barrett’ s metaplasia. Clinical follow - up of Barrett ’s esophagus Significance.