The Diagnosis Of Magnification Chromoendoscopy To Different Subtypes Of Intestinal Metaplasia And The Relations With Cdx2,MUC2,MUC5AC

Objective To investigate the diagnostic value of magnification chromoendoscopy to intestinal metaplasia and its different subtypes, and their relations with Cdx2, MUC2, MUC5AC is also evaluated. Methods 66 outpatients refer to conventional gastroendoscopy examination and 18 patients with intestinal metaplasia were enrolled randomly in the study. Endoscopy examination was performed with a magnification endoscopy after methylene blue(0.5%) spraying. According to differences in color and mucosal pattern, groups and subgroups of endoscopic images were defined, and biopsies were taken for histological assessment. Result 1. Methylene blue mucosal staining is a more highly accurate and valuable method of diagnosing intestinal metaplasia ( 62.1% ) than conventional technique ( 5.2% ) . 2. Methylene blue chromoendoscopy is highly sensitive (86. 7%) and specific (79.5%) in diagnosisof intestinal metaplasia. 3. Age, gender, history and symptoms are not the sensitive marks of intestinal metaplasia in outpatients (P>0.05). 4. The mean of age in patients with colonic type IM is significantly higher than that in small intestinal type IM(61.62±11.43 vs 54.10± 11.03), and the gender is unlikely to be clinically useful for discrimination between colonic type IM and small intestinal type IM (P>0.05) . 5. Cdx2 and MUC2 are widespreadly expressed in all types of IM. While MUC5 AC expression rate in patients with incomplete IM is higher than that in complete IM (81.5% vs 29.7%, p<0.05) , either in colonic type IM or in small intestinal type. 6. Magnification chromoendoscopic images can be classified to 4 groups: A, amorphous type; B, reticular type; C, elliptical type; D, dot type. Images of group A and B are more often associated with colonic type IM(32. 6%, 39. 5%), and group C and D with small intestinal type IM(25. 0%, 43. 8%). 7. Cdx2 and MUC2 has no association with the types of magnifying appearances in the blue areas, while MUC5AC is likely more often observed in group A (81. 3%) and D(68. 2%) but not in group B(53. 3%) and C(47. 8%). Conclusion Magnification chromoendoscopy is more efficient and valuable in the survillance of IM, and according to the mucosal patterns endoscopist can make a primary judgement to the type of IM, which may be association with the abnormality of biochemistic character in metaplastic cells, such as the atopic expression of Cdx2.