Endoscopic Diagnosis Of Intestinal Metaplasia Research Articles

Barrett's Esophagus and Intestinal Metaplasia.

Intestinal metaplasia refers to the replacement of the differentiated and mature normal mucosal epithelium outside the intestinal tract by the intestinal epithelium. This paper briefly describes the etiology and clinical significance of intestinal metaplasia in Barrett’s esophagus. This article summarizes the impact of intestinal metaplasia on the diagnosis, monitoring, and treatment of Barrett’s esophagus according to different guidelines. We also briefly explore the basis for the endoscopic diagnosis of intestinal metaplasia in Barrett’s esophagus. The identification techniques of goblet cells in Barrett’s esophagus are also elucidated by some scholars. Additionally, we further elaborate on the current treatment methods related to Barrett’s esophagus.

The Accuracy of Endoscopic Diagnosis of Intestinal Metaplasia Compared to Histopathological Diagnosis

The Accuracy of Endoscopic Diagnosis of Intestinal Metaplasia Compared to Histopathological Diagnosis

Endoscopic Classification of Intestinal Metaplasia

Intestinal metaplasia (IM) is recognized as a precancerous condition for intestinal type gastric cancer. Therefore, endoscopic diagnosis of IM is valuable for patients undergoing surveillance endoscopy. However, there are no standard endoscopic findings that distinguish it from the normal mucosa. Thus, biopsy is normally required to confirm the diagnosis of IM. Recently, the development of high-resolution image technique and some advanced endoscopic technologies such as chromoendoscopy, magnifying endoscopy with narrow band image and confocal laser endomicroscopy has significantly improved the ability to observe mucosal surface and identify IM. Although chromoendoscopy is time consuming, it is a useful method for diagnosis of IM. Narrow band imaging may enhance the accuracy of endoscopic surveillance of IM and dysplasia. Confocal laser endomicroscopy could provide in the real-time identification and classification of IM. Herein, we reviewed the clinical usefulness of white light endoscopy and several new endoscopic methods for the diagnosis of gastric intestinal metaplasia. Also, we will discuss appropriate follow-up period according to IM type and extension. (Korean J Helicobacter Up Gastrointest Res 2013;13:78-83)

Predictability of Gastric Intestinal Metaplasia by Mottled Patchy Erythema Seen on Endoscopy.

BackgroundIntestinal metaplasia (IM) is regarded as a premalignant lesion. However, endoscopic diagnosis of IM has been considered difficult. Using endoscopy, we found a unique pattern of erythema, “Mottled Patchy Erythema (MPE),” which includes severe IM. Helicobacter pylori (Hp) infection itself can cause erythema, which reflects histologic changes in the gastric mucosa. Therefore we enrolled Hp eradication patients to validate the relation between MPE and pathologic findings.MethodsWe enrolled patients with chronic gastritis who underwent successful Hp eradication at least 6 months before the study. We defined MPE as multiple flat or depressed erythematous lesions. When encountering MPE on endoscopy, we performed biopsy on both the MPE site and non-MPE site. The non-MPE site was defined as an adjacent mucosa located within 3 cm of the MPE site. All biopsy specimens were evaluated immunohistochemically for IM subtype using MUC2, MUC5AC, MUC6, CD10, and CDX2 stains. The degree of IM was defined according to the Updated Sydney System. The diagnostic accuracy of the MPE findings for pathologic IM was calculated. The relation between MPE and IM subtype was also assessed.ResultsA total of 102 patients were selected for the study. Of these, 55 (54%) patients had MPE. Biopsy specimens were taken from the MPE sites and non-MPE sites from these 55 patients. The IM percentages and median scores of IM were both significantly higher at the MPE sites (P < 0.001) than at the non-MPE sites. The sensitivity and specificity for MPE in the detection of histologic IM were 72.7% and 84.1%, respectively. No significant associations were observed in the expression of MUC2, MUC5AC, MUC6, CD10, and CDX2 between the MPE sites and non-MPE sites. There were no significant differences in the ratios (complete/incomplete) of IM subtypes between the two groups.ConclusionsMPE is a useful endoscopic finding to detect histologic IM without the use of chromoendoscopy and magnifying endoscopy. However, the IM subtype is difficult to identify. In the era of Hp eradication, MPE has the potential to become a predictive finding for the risk of gastric cancer.

Light blue crest (blue fringe): endoscopic diagnosis of pathology

I have been greatly interested in the meaningful data from Tahara et al. presented in response to our reported finding using magnifying narrow band imaging (NBI). The authors suggested that a finding of the light blue crest by magnifying NBI, especially in the gastric corpus, could be a good indicator of high risk for the development of gastric cancer. I think their data highlight two important points about endoscopic diagnosis of intestinal metaplasia in the stomach.

Methylene blue staining for the endoscopic diagnosis of intestinal metaplasia in the stomach

Methylene blue staining for the endoscopic diagnosis of intestinal metaplasia in the stomach

Endoscopic diagnosis of antral intestinal metaplasia

500 patients without antral ulcer or tumor were studied with regards to intestinal metaplasia on the basis of endoscopic features and histological data.The patients were divided into 3 groups: 1) Antrum with «Flat Red Plates»; 2) «Urticaria-Like» antral aspect; 3) Absence of characteristic antral features. Intestinal metaplasia was present in approximately 90% of cases with antral «Flat Red Plates» and in about half of the cases with «Urticaria-Like» aspect. The results show the importance of macroscopic features in the endoscopic diagnosis of intestinal metaplasia.

Endoscopic diagnosis of intestinal metaplasia in asymptomatic (control) volunteers

The F-P border and strain phenomenon of the gastric mucosa were investigated by the application of methylene blue dye spraying method in endoscopy to 105 asymptomatic control volunteers and the following results were obtained; 1. The pyloric metaplasia is observed in the fundic gland area from the twenties in age and becomes increasing in its number and move widely spreading from the lesser curvature to the anterior and/or posterior wall of the corpus with advancing age. 2. The intestinal metaplasia arises from the thirties in age. 3. The intestinal metaplasia is observed either in the pyloric gland area of following the pyloric metaplasis in the fundic gland area. 4. Histologically, the strain phenomenon of the gastric mucosa is closely related to the intestinal metaplasia. Then, methylene blue dye spraying method is reevaluated to be useful for a precise endoscopic diagnosis of intestinal metaplasia.

Endoscopic diagnosis of intestinal metaplasia of the stomach and its evaluation as a precancerous lesion.

Endoscopic diagnosis of intestinal metaplasia of the stomach and its evaluation as a precancerous lesion.

In Vivo Staining of Gastric Mucosa: Its Application to Endoscopic Diagnosis of Intestinal Metaplasia

In Vivo Staining of Gastric Mucosa: Its Application to Endoscopic Diagnosis of Intestinal Metaplasia