| BackgroundUpper gastrointestinal endoscopy examination is one of the most important methods in diagnosis of upper gastrointestinal lesions.With the rapid development and application of narrow-band imaging,especially the magnifying endoscopy combined with narrow-band imaging,the detection rate of superficial and minor lesions is increasing.Narrow-band imaging plays an important role in the early detection,early diagnosis and early treatment of the upper gastrointestinal tract disease.However,magnifying endoscopy combined with narrow-band imaging requires longer examination time and more expensive endoscopic equipment.At present,the number of patients who need to be screened in China is large,and most of procedures are performed without sedation and analgesia,resulting in the patients' intolerance,affecting the quality of the examination.In addition,most hospitals are unable to be equipped with sufficient magnification endoscopies,limiting its further application.The narrow-band imaging mode switching is convenient and rapid,without the risk of complications of traditional staining endoscopy,and would not be affected by the type of endoscopy.Thus,the clinical application of narrow-band imaging for the screening of upper gastrointestinal superficial mucosal lesions is cheaper,more efficient,and more acceptable.Nevertheless,further study of the effectiveness and application value of narrow-band imaging in screening upper gastrointestinal superficial mucosal lesions is still needed.Part One: A preliminary study of the diagnostic value of narrow-band imaging in upper superficial gastrointestinal mucosal lesions.ObjectiveTo compare the differences between the narrow-band imaging mode and the conventional white light imaging mode in the detection of upper gastrointestinal superficial mucosal lesions,and to evaluate the usability and repeatability of the narrow-band imaging.MethodsFrom July 2014 to April 2017,patients with upper gastrointestinal superficial mucosal lesions and complete conventional white light,narrow band imaging and pathological data were collected.The conventional white light images and narrow band images of upper superficial gastrointestinal mucosal lesions were examined by a junior physician and a senior physician,respectively.The diagnostic concordance of two physicians was assessed,and the detection rates of lesions in the white light mode and narrow-band imaging mode was compared.ResultsA total of 175 patients with upper gastrointestinal superficial mucosal lesions were collected,including 43 esophageal lesions(24.57%),60 gastric lesions(34.29%),and72 duodenal lesions(41.14%).In the conventional white light imaging model,the detection rates of esophageal,gastric and duodenal superficial mucosal lesions of the junior physician were 55.81%,68.33% and 91.67%,respectively.In the narrow-band imaging mode,the detection rates of esophageal,gastric and duodenal superficial mucosal lesions of the junior physician were 93.02%,95.00% and 95.83%,respectively.The detection rates of esophageal and gastric lesions between the two models were significantly different,p<0.05.There was no significant difference in the detection rateof duodenal lesions between the two modes,p>0.05.In the conventional white light imaging model,the detection rates of esophageal,gastric and duodenal superficial mucosal lesions of the senior physician were 58.14%,73.33% and 91.67%,respectively.In the narrow-band imaging mode,the detection rates of esophageal,gastric and duodenal superficial mucosal lesions of the senior physician were 97.67%,95.00% and97.22%%,respectively.The detection rates of esophageal and gastric lesions between the two models were significantly different,p<0.05.There was no significant difference in the detection rate of duodenal lesions between the two modes,p>0.05.There was no significant difference in the detection of all the same lesions between the two physicians in the conventional white light model or the narrow-band imaging model,and the The kappa values were 0.88 and 0.79,respectively.ConclusionNarrow-band imaging can improve the detection rates of esophageal and gastric superficial mucosal lesions in the upper gastrointestinal endoscopic examinations and exhibits satisfactory usability and repeatability.Part Two: The screening value of narrow-band imaging in patients with duodenal superficial mucosal lesions.ObjectiveA preliminary analysis of diagnostic value of narrow-band imaging in patients with duodenal superficial mucosal lesions.MethodsThe outpatient and hospitalized patients undergoing endoscopic examination after diagnosis of duodenal superficial mucosal lesions were collected.Patient were dividedinto different groups according to the pathological diagnosis.Endoscopic images of each patient were obtained to observe and record the distribution of lesions,fusion of multiple lesions,lesion size,vascular pattern and surface pattern.Then we analyzed the differences between different groups.ResultsA total of 72 cases with duodenal superficial mucosal lesions were collected,including 35 cases of inflammatory lesions(48.61%),17 cases of heterotopic gastric mucosa(23.61%),12 cases of gastric duodenal metaplasia(16.67%)and 8 cases of duodenal adenoma(11.11%).Image features of the four types of duodenal lesion were analyzed.Solitary duodenal adenomatous lesions were observed more frequently and larger in diameter size compared with the other three groups.There was no significant difference in the surface pattern features between the inflammatory lesions and the surrounding background mucosa.Vascular pattern and fusion might be helpful for differentiating the duodenal superficial elevated lesions.ConclusionWhen duodenal superficial mucosal lesions were found during the upper gastrointestinal endoscopic procedures,the lesions could be identified preliminarily with the application of narrow band imaging to improve the endoscopic diagnostic accuracy.Meanwhile,misdiagnosis and overtreatment could also be avoid maximally. |
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