| BackgroundBarrett’s Esophagus (BE) is a pathological phenomenon which the lower esophageal mucosa of stratified squamous epithelium is replaced by simple columnar epithelium. It’s a precancerous lesion, an annual average of about0.5%of patients with cancer may develop esophageal adenocarcinoma, the risk of esophageal adenocarcinoma in30-50times higher than the general population. BE is divided into three types through the different sources of columnar epithelium, gastric type:visible chief cells and parietal cells; cardia type:visible mucous glands, chief cells and parietal cells; special type of intestinal metaplasia type:goblet cells their characteristics. According to the2006"gastroesophageal reflux disease consensus" with special intestinal metaplasia were only a precancerous lesion of esophageal adenocarcinoma.Emphasized the endoscopic and histopathological examination for the diagnosis of BE, general endoscopists think BE is that pink lesions in endoscopic, without emphasis on specific intestinal metaplasia with goblet cells in the biopsy; and pathologist sometimes focus only on the columnar epithelium with goblet cells while ignoring the biopsy site, so there is a disconnect in the endoscopic diagnosis and pathological diagnosis, resulting in a misdiagnosed of BE. This topic is based As mentioned above, We study the diagnosis value of Barrett’s esophag which based on the i-scan endoscopy and confocal laser endoscopy, thereby enhancing the rate of diagnosis of Barrett’s esophagus and explore a new effective method for the diagnosis of Barrett’s esophageal.i-scan is a special optical imaging technology, composed of red, green, and blue light. Longer wavelengths of light, the stronger the penetration of light in the same organization to reach the deeper the mucosal level, in addition, the organizational structure and blood flow impacted spectral absorption, reflection. red band can be used to display the submucosal vascular network which the penetration depth is240nm; The green-band can show the blood vessels of the middle layer which the penetration depth is200nm;blue-band penetration depth shallower only170nm, therefore it’s good for observe the mucosal surfaces of blood vessels, therefore, the mucous membrane of the superficial blood vessels is mainly characterized by a dark brown, deeper mucous membrane show a blue-green, which display the rich vascular lesions (such as inflammation, malignant mass) and to assess the lesion depth is extremely important, but its actual clinical value remains to be more research. i-scan can show some lesions and organizational characteristics which can not be displayed in traditional endoscopic and provide a reliable basis of precise endoscopic diagnosis and biopsy,which improve the detection rate of dysplasia and cancer tissue. But there is only a very small reports about the i-scan’s characteristics of the BE. the diagnostic value needs more research.Confocal laser endoscopy (Confocal laser endomicroscopy, CLE) is a new invention of endoscopic techniques In recent years which add the core confocal probe from the traditional endoscopic, and formation the direct observation of the endoscopic gastrointestinal mucosa and submucosa cells, sub-cells and even the molecular level imaging and targeted biopsy of the lesion which improving the accuracy of biopsy, this "optical biopsy" will challenge the traditional histopathological examination.Therefore it has a unique advantage in the diagnosis of gastrointestinal tumors and precancerous lesions. Confocal endoscopic required application of a fluorescent contrast agent in the inspection process.the most commonly used in the human body with10%sodium fluorescein and0.05%hydrochloric acid acridine yellow. Sodium fluorescein is a cheap, no mutagenic effect of the fluorescent contrast agent, with a slightly acidic and hydrophilic characteristics, binding to serum proteins after injection, the unbound dye molecules with intravenous gradually penetrated into the mucosa mark extracellular matrix and basement membrane of the surface epithelium, showing the structure of crypt epithelial cells, lamina propria connective tissue matrix, blood vessels and red blood cells,connective tissue matrix and the microvascular system to produce a strong contrast. Within30s after intravenous sodium fluorescein to imaging and its role in sustainable30min. Sodium fluorescein can not pass through the lipid membrane of the cell nucleus acid, in the confocal microscope is not easy to see the nucleus, but the cells, blood vessels and connective tissue with higher resolution. Hydrochloric acid acridine yellow can make the nucleus and cytoplasm staining, topical application of a few seconds can be absorbed, but only limited to the mucosal surface (vertical50um), the detection of dysplasia and tumors is extremely favorable, but with a slight mutagenic activity, clinical application is more cautious.Kiesslich et al study found that the sensitivity of confocal endoscopy to diagnose Barrett’s esophagus and esophageal adenocarcinoma were98.1%,92.9%, the specificity was94.1%,98.4%, domestic LIU et al. Consistent with this. In addition, confocal endoscopy’s smart targeted biopsy characteristics compared with traditional endoscopy has a unique advantage, Kerry B et al show that the confocal endoscopic made the Barrett’s esophagus the number of biopsy decreased59%,and the number of diagnostic yield increased16.5%. we can conduct targeted biopsy and organize cells of live observation at the same time through Confocal microscope. In summary, confocal endoscopy may play an important value on the diagnosis of BE, the lack of uniform standards for the diagnosis of BE in present, this study of a preliminary exploration will be conductedResearch shows that Barrett esophageal can develop into esophageal adenocarcinoma, therefore, Barrett esophageal should be treatment and follow-up Endoscopic argon injection coagulation (APC) therapy is an acute mucosa damage, it was first used in endoscopic treatment of the Digestive system disease in1991. The treatment principle is through the argon form of high frequency flow on local mucous membrane for burning, formation of certain depth mucosa damage, destroy abnormal epithelial, make mucosa effectively coagulation necrosis. Every time APC treatment organization surface has set a depth of3-5mm, scope of electricity is wide, can deal with large areas of Barrett epithelial, Due to the limited depth of mucosal injury caused by APC, so the fewer opportunities perforation and stricture. Because of its fewer complications, complete resection rate is higher, abroad extensively, and as an important treatment for Barrett’s esophagus, and domestic were also reported in this regard, but the high-power APC treatment of Barrett’s esophagus and long time follow-up evaluation of its efficacy and safety reported are less. We Treatment of a group of patients with Barrett’s esophagus useing APC combined with acid suppression therapy, and conduct a12-month follow-up to investigate the efficacy、 safety and clinical efficacy.Therefore, the subject focuses on the diagnosis value of i-scan and confocal endoscopy for BE, Study the value in the diagnosis of Barrett’s esophagus.Improving the rate of diagnosis of Barrett’s esophagus, and exploring new and effective method for diagnosis of Barrett’s esophagus.Therefore,we can make the"therapy window" of Barrett epithelial related to esophageal adenocarcinoma in advance.and at the same time resecting the mucosa in endoscopic,Therefore,we can make the"therapy window" of Barrett epithelial related to esophageal adenocarcinoma in advance.Objectives:To explore i-scan endoscopy and confocal laser endomicroscopy for diagnosis Barrett’s esophagus and assess the efficacy and safety of the treatment of Barrett’s esophagus Using high-power APC.Materials and Methods1. MaterialsWe seleceted a total of878patients with gastrointestinal symptoms (acid reflux, heartburn, belching, swallowing a sense of stem pharynx, upper abdominal pain, etc.) who received endoscopy in the Digestive endoscopy center of the Third Affiliated Hospital of Southern Medical University in July2010to July2011, except for esophageal, stomach, duodenum surgical history and physical examination, endoscopy, gastrointestinal barium meal examination found that stomach cancer, esophageal cancer.2. MethodsWe use the Pentax, the EPK-i gastroscopy (normal and i-ssan model) and Pentax, the ISC-1000confocal laser endomicroscopy.A total of878outpatient underwent normal endoscopy and i-scan inspection, comparison the detection rate of Barrett’s esophagus between normal endoscopy and i-scan. The endoscopic screening of patients with suspected Barrett’s esophagus accept the confocal laser endoscopy to observe the Battett epithelial characteristics, and biopsy of the lesion, The results of confocal endoscopic images and pathological samples were compared. Finally, We treated patients of BE for APC by wishes who confirmed by endoscopy and pathology, if the BE is more than4cm in length, can be divided into2or more times. After treatment, all patients were given omeprazole20mg Bid,1to4weeks until symptoms completely eliminated. all patients, respectively, each section1,6,12months make the first endoscopic follow-up after APC treatment. We need to take biopsy the suspected columnar epithelium residual in Endoscopic follow-up,at the smee time the ablation therapy of APC should be conducted again.Results:1. Total of878cases of patients meet the criteria which included in the study.The detection rate of BE between i-scan and ordinary electronic endoscope was no significant difference (6%versus5%p>0.05);2. The detection rate of paliform blood vessels between SCJ and GEJ Was higher using i-scan than ordinary endoscope (67.3%versus45.7%, p<O.05).3. The histopathological diagnosis of Barrett’s esophagus in14cases, the confocal laser endomicroscopy diagnosis of Barrett’s esophagus in13cases.Barrett’s esophagus could be diagnosed by confocal endomicroscopy with a sensitivity of93%, a specificity of100%.4.14cases of patients with a total treatment of21times (mean per patient1.5)(Set power:70W), which are up to complete reversal of endoscopy and histology.Conclusions: 1. i-scan is significance for the observations the extent of disease, the boundaries and the fence-like blood vessels between the esophageal mucosa at the squamocolumnar junction (SCJ) and the Gastroesophageal junction (GEJ), and can improve the detection rate of suspected BE;2. CLE make real-time in vivo tissue diagnosis possible, it’s diagnostic sensitivity and specificity of BE were higher.3. i-scan and CLE can show the main morphological features of Barrett’s epithelium, and the BE tissue typing, which is the traditional endoscopic can not reach, because of the small study sample size, we need further large sample study confirmed.4. our study shows that argon plasma coagulation for elimination of Barrett’s epithelium is effective(Set power:70W), can metaplasia of the columnar epithelium reversed squamous epithelium, it’s safety and small side effects. |
PDF Full Text Request