| Background:Gastric cancer is one of the most common malignant tumors in the digestive tract,and the majority of it progresses from precancerous lesions.The prompt detection of these lesions plays a vital role in the diagnosis and treatment of gastric cancer,which can reduce the patient’s treatment costs and increase the cure rate.However,the appearance of gastric precancerous lesions is not obvious under endoscopy,and it is not easy to be found.The emergence of chromoendoscopy technology provides the possibility for early detection of lesions under endoscopy.Acetic acid is currently a commonly used mucosal dyes,which mainly improves the recognition rate of endoscopic lesions by improving the visibility of the mucosal microstructure and the increased acetowhitening than normal areas phenomenon of the diseased mucosa.The commonly used dyeing method for chromoendoscopy is targeted staining,that is,spray staining agents in suspicious lesions and surrounding mucosa under direct vision of the endoscope to improve the contrast between the mucosa of the lesion and the normal mucosa.However,this method has the following defects:(1)This method has been used for more clearly visualizing suspicious lesions already detected and not for detecting lesions more easily;(2)The inability to obtain the staining of the entire stomach may result in omission of the lesion;(3)For patients with multiple lesions,The spraying process is particularly time-consuming.We have,thence,designed a new staining method to stain the gastric lumen through oral acetic acid solution.Based on pathological diagnosis,we observed whether Per-oral acetic acid chromoendoscopy(AAC)can improve the detection rate of gastric mucosal lesions.Objective:1.The purpose of the study was to compare the detection effectiveness of Per-oral acetic acid chromoendoscopy ordinary white light endoscopy for sreeening gastric mucosal lesions.2.Discuss the safety of oral acetic acid solution stain and the success rate of total staining.Methods:1.Pilot study1.1 10 volunteers were enrolled,orally take 100 ml of 2.5% acetic acid solution,observing the immediate adverse reactions after oral administration and follow up for the occurrence of adverse reactions 24 hours later.1.2 15 volunteers were included,orally take 100 ml of three different concentrations of acetic acid solution of 1.5%,2% and 2.5% respectively,observing the characteristics of staining under endoscopy,and the clarity of each part of the gastric mucosa.2.Prospective studyPatients who underwent gastroscopy at the Digestive Endoscopy Center of the First Affiliated Hospital of Nanchang University from January 2020 to July 2020 were included.A random number table was used to divide the patients into 2 groups.All patients in each group will be given pronase and lidocaine hydrochloride.Afterwards,the experimental group(acetic acid group)was given a gastroscopy after oral administration of 100 ml of 2% acetic acid solution,and the control group(clear water group)was given a routine gastroscopy after oral administration of 100 ml of water.In both groups,multiple biopsies were taken from suspicious lesions and sent for histopathological examination.At the same time,the operation time and gastric mucosal clarity score of the two groups were compared.The length of time from the end of oral acetic acid solution to endoscopy in experimental groups.The staining success rate of the oral acetic acid solution group was evaluated.Observing the occurrence of serious events such as aspiration and shock during gastroscopy,adverse reactions after oral administration of reagents and the occurrence of adverse reactions one day after telephone follow-up.Results:1.Pilot study1.1 2 volunteers experienced acid reflux after oral administration of 100 ml of acetic acid solution,and the remaining 8 volunteers did not complain of discomfort.One day later,a telephone follow-up was conducted,and none of the 10 volunteers complained of discomfort.1.2 After oral administration of 100 ml of 1.5% acetic acid solution,endoscopic observation found that the staining effect was not obvious,and the effect of improving the visibility of the mucosal surface and highlighting the lesion mucosa was not significant;after oral administration of 100 ml of 2.5% acetic acid solution,endoscopic observation of the stomach was performed a large amount of mucus adheres to the mucosal surface,and the visibility is poor.Oral 2% concentration of acetic acid stains better.In terms of gastric mucosal clarity,the endoscopic scores of mucosal clarity in patients with oral 1.5% and 2% acetic acid were better than those with 2.5% acetic acid.According to the endoscopic staining and mucosal clarity,2%concentration of acetic acid solution was finally selected as the best oral concentration for this study.2.Prospective studyA total of 200 patients were enrolled in the study.According to the exclusion criteria,165 patients were finally included for data analysis.Among them,75 cases were in the experimental group(male/female=37/38 cases,with an average age of51.13±9.04 years),and 90 cases in the control group(male/female = 37/38 years)and90 cases in the control group(male/female = 37/38 years).Female=40/50 cases,average age 49.56±9.90 years).The mucosal staining success rate of the experimental group was 78.7%(59/75),and the staining failure rate was 21.3%(16/75).The average operation time of the experimental group was 7.63±2.28 min,and the average operation time of the control group was 7±1.93 min.There was no significant difference in overall operation time between the two groups(p=0.058).The average length from the end of oral acetic acid solution to gastroscopy starting in the experimental group was 6.43±2.27 min.The incidence of aspiration during gastroscopy in the two groups was 0.In the experimental group,2 people(2.67%)developed hypotension during gastroscopy,and their blood pressure remained stable after rehydration.Compared with the control group,the detection rate of intestinal metaplasia in the experimental group [52%(39/75)than 24.4%(22/90)] was higher,and there was no statistically significant in the overall polyps detection rate between the two groups(P=0.247).The detection rate of glandular polyps in the experimental group was significantly higher than that in the control group [13.3%(10/75)vs.3.3%(3/90)].No statistically significant difference regarding the detection rate of intraepithelial neoplasia and gastric cancer between the two groups(P=0.22).In the experimental group,7(9.3%)people experienced abdominal discomfort after oral administration of acetic acid.Follow-up results showed that two of them remained symptoms 24 hours after gastroscopy.All patients were followed up,there was no statistical difference between them in terms of adverse effects.Conclusions:1.Orally take 100 ml of 2% acetic acid solution to stain the gastric mucosa.The staining success rate is higher and the visual field is clear.2.Oral-acetic acid staining can significantly increase the discovery rate of gastrointestinal metaplasia and gastric gland polyps.3.Gastroscopy after oral administration of 100 ml of 2% acetic acid solution will not increase the occurrence of related adverse reactions. |
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