| Esophagogastric junction(EGJ)is the junction of the distal esophagus segment and the proximal stomach,and histologically,it referred to the transition from squamous epithelium to column epithelium.Anatomically,the distal end of the esophagus is the lower esophageal sphincter,which is not a real structure,but a high-pressure area of gastrointestinal dynamics,so the esophagogastric junction is mostly closed,and there are many folds in this part,the minor lesions of EGJ are mostly in an hidden state and not easy to be found,and there are no obvious clinical manifestations in the early stage,it is mostly diagnosed in the middle and late stage.Blue laser magnifying endoscope is a new generation of endoscope introduced by Fuji Company in Japan in recent years.The image can be enlarged to 135 times,which changes the situation that it is difficult to detect the micro vessels and micro structures on the mucosal surface using White light imaging(WLI)in the past,and improves the recognition of early cancerous lesions and precancerous lesions.Blue laser image-bright(BLI-bright)is one of the modes,if the magnifying endoscopy(ME)is adjusted to 20-40 times in this mode,the mucosal glandular canal structure can be clearly seen,which is helpful for the detection of EGJ minor lesions.The mucosal glandular canal structure was observed under blue laser imaging-bright plus low magnifying endoscopy(BLI-bright+ME)in this study,to explore whether it is valuable in the detection of early cancer and precancer of EGJ.Objective:To compare the detection rate and biopsy rate of EGJ minor lesions of BLI-bright+ME mode and WLI mode,and the corresponding pathological conditions(inflammatory lesions,precancerous lesions,cancerous lesions)were further compared.The detection rate and biopsy rate of EGJ minor lesions above and below the dentate line were further compared under the two modes.In addition,the consistency test and the summary analysis were conducted on the microscopic diagnosis obtained by observing the glandular duct structure in the BLI-bright+ME mode and postoperative biopsy pathology,in order to explore the diagnostic advantages of BLI-bright+ME mode for EGJ minor lesions.Methods:Prospective collection of patients with suspected gastric or esophageal diseases who undergoing LASEREO system gastroscopy in our hospital from June 2021 to April 2022,the patients were divided into BLI-bright +ME group(even number)and WLI group(odd number)according to the difference of the last digit of the medical card number.In the BLI-bright +ME group,EGJ was observed in the BLI-bright +ME mode,in the WLI group,EGJ was observed in the WLI mode.Morphological changes such as eminence or depression on the surface of the EGJ mucosa,tonal changes and the roughness of the mucosa were all carefully observed in two modes.In the BLI-bright +ME group,expansion,inhomogeneity and absence of the glandular duct structure should be also carefully observed.Biopsies were performed on those with abnormal glandular duct structure in the BLI-bright+ME group,in the WLI group,biopsies were performed on suspicious sites such as unclear lesion boundaries and rough mucosal surface.According to the lesions manifestation of EGJ,the detected cases of minor lesions in the two modes were collected respectively,according to the biopsy situation of cases of the two groups,the number of cases of inflammatory lesion,precancerous lesion and cancerous lesion were collected respectively.The number of detected and biopsied cases of minor lesions above and below the dentate line of EGJ were further collected under the two modes.Chi-square test or Fisher’s exact probability method were used for comparison,P<0.050 was considered as the statistically significant difference.Whether there were statistical differences in the detection rate and biopsy rate of EGJ minor lesions,and corresponding pathological conditions(inflammatory lesions,precancerous lesions,cancerous lesions),and the detection rate and biopsy rate of minor lesions above and below the dentate line of EGJ between the two modes.According to the glandular duct structure was observed under the BLI-bright+ME mode,the number of cases of minor lesions below the dentate line of EGJ diagnosed as inflammatory lesions,precancerous lesions and cancerous lesions under the microscope was collected,and the number of cases of duct dilatation,duct ununiformity and duct deletion was collected;according to the biopsy conditions,the number of cases in the BLI-bright+ME group that were pathologically diagnosed as inflammatory lesions,precancerous lesions and cancerous lesions were collected.Kappa test was used for consistency analysis,P < 0.050 was considered as the statistically significant difference,to analyze the consistency of microscopic diagnosis and postoperative biopsy pathological diagnosis of minor lesions of EGJ under the BLI-bright+ME mode.Results:1.There are 224(37.83%)EGJ minor lesions were detected in 592 patients in BLI-bright+ME group and 152(25.76%)in 590 patients in WLI group,148(25.00%)biopsies were performed in BLI-bright+ME group,72(12.20%)biopsies were performed in WLI group,the detection rate and biopsy rate of EGJ minor lesion in BLI-bright+ME group was higher than that in WLI group,the difference was statistically significant(P<0.001,P<0.001).2.In the BLI-bright+ME group,83 cases(14.02%)of inflammatory lesions,61 cases(10.30%)of precancerous lesions,and 4 cases(0.68%)of cancerous lesions were detected.In WLI group,55 cases(9.32%)of inflammatory lesions,17 cases(2.88%)of precancerous lesions and 0 cases(0.00%)of cancerous lesions were detected.The detection rates of inflammatory lesions,precancerous lesions and cancerous lesions in the BLI-bright +ME group were better than those in the WLI group,and the differences were statistically significant(all P<0.050),especially in the detection rate of precancerous lesions(P< 0.001).3.A total of 224 cases(37.83%)of EGJ minor lesions were detected in the BLI-bright+ME group,86 cases(14.52%)above the dentate line of EGJ,138 cases(23.31%)below the dentate line of EGJ;148 cases(25.00%)biopsies were performed,including 31 cases(5.24%)above the dentate line of EGJ,117 cases(19.76%)below the dentate line of EGJ.A total of 152cases(25.76%)of EGJ minor lesions were detected in the WLI group,81cases(13.73%)above the dentate line of EGJ,71 cases(12.03%)below the dentate line of EGJ,72 cases(12.20%)biopsies were performed,including22 cases(3.73%)above the dentate line of EGJ and 50 cases(8.47%)below the dentate line of EGJ.There was no significant difference in the detection rate and biopsy rate of minor lesions above the dentate line of EGJ(P>0.050,P>0.050),The detection rate and biopsy rate of minor lesions below the dentate line of EGJ in the BLI-bright+ME group were significantly higher than those in the WLI group,and the difference was statistically significant(P<0.001,P<0.001).4.Microscopic diagnosis of EGJ minor lesions below the dentate line was concluded by observing the glandular duct structure in BLI-bright+ME mode,there were 68 cases of inflammatory lesions,46 cases of precancerous lesions,and 3 cases of cancerous lesions.Pathological diagnosis of postoperative biopsy showed 65 cases of inflammatory lesions,48 cases of precancerous lesions and 4 cases of cancerous lesions.In the BLI-bright+ME group,the concordance rates of inflammatory lesions,precancerous lesions,cancerous lesions between microscopic diagnosis and pathological diagnosis of postoperative biopsy were 95.3%(62/65),87.5%(42/48)and 75.0%(3/4),respectively.Consistency test was performed,and Kappa value was0.834>0.750,p<0.001,good consistency.5.In the BLI-bright+ME group,117 cases of EGJ minor lesions below the dentate line were biopsied,including 57 cases of glandular duct dilatation,56 cases of uneven glandular duct,and 4 cases of glandular duct deletion.There were 65 cases of inflammatory lesions,48 cases of precancerous lesions and 4 cases of cancerous lesions according to biopsy pathological result.In the BLI-bright+ME group,the minor lesions of mucosal glandular duct dilatation below the dentate line were mainly inflammatory lesions(70.7%,46/65),the minor lesions of uneven glandular duct were mostly precancerous lesions(75.0%,36/48),and the minor lesions of glandular duct deletion should be noted for the possibility of cancerous lesions(75.0%,3/4).Conclusions:1.Compared to WLI mode,BLI-bright+ME mode can improve the detection rate and biopsy rate of EGJ minor lesions,especially for the detection of minor lesions below the dentate line of EGJ.2.By observing the mucosal glandular duct structure of minor lesions,BLI-bright+ME model significantly improved the sensitivity to detect precancerous lesions below the dentiate line of EGJ,and improved the diagnosis rate of early cancer of EGJ.3.In the BLI-bright+ME model,minor lesions below the dentate line of EGJ were mainly mucosal glandular duct dilatation,uneven glandular duct take second place,glandular duct deletion was rare.The minor lesions below the dentate line of EGJ,the inflammatory lesions were mainly glandular duct dilatation,the precancerous lesions were mostly uneven glandular duct,and the cancerous lesions were mostly glandular duct deletion. |
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