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      Unión escamo columnar y metaplasia intestinal en esófago: magnificación y FICE Translated title: Scomo columnar junction and intestinal metaplasia in esophagus: Diagnosis with magnyfication and fice

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          Abstract

          La endoscopia estándar no identifica Metaplasia Intestinal en Esófago. Su presencia se ha relacionado con el tipo de Unión Escamo Columnar. La endoscopia de alta resolución con magnificación, colorantes vitales y virtuales aumenta su diagnostico. Objetivo Asociar la presencia de Metaplasia Intestinal con el tipo de Unión Escamo Columnar, utilizando endoscopia de alta resolución, magnificación y Cromoscopia Virtual con FICE corroborándolo con histología. Pacientes Previo consentimiento verbal se incluyeron prospectivamente a los individuos que tenían indicación electiva de endoscopia digestiva superior. Materiales y Métodos Se utilizó para endoscopia digestiva superior equipo Fujinon Inc. EG 590 ZW, con procesador EPX 4400 que provee efecto FICE con Cromoscopia Virtual Computada. Se utilizó magnificación y FICE. Se clasificó la Unión Escamo Columnar según Wallner en cuatro tipos y se correlacionaron con la presencia de Metaplasia Intestinal. Se grabó en DVD, se congeló durante 3 segundos la imagen deseada y se fotografió cada hallazgo de interés guardado en JPEG en programa Power Point. Se tomó biopsia del patrón sugestivo de Metaplasia Intestinal. Los patólogos evaluaron las láminas sin tener datos del paciente. Resultados Se incluyeron 120 pacientes (p): 44 hombres y 76 mujeres con edad de 20-85 años. Se identificaron los tipos de Unión Escamo Columnar y patrones de mucosa descritos en la literatura y se correlacionaron con la histología. La Unión Escamo Columnar tipo GII se encontró en 45,09% y el Patrón Pit T3 se asoció en 87,5% con GIII. Conclusión Con FICE se evalúa e identifica mejor el tipo de Unión Escamo Columnar y Metaplasia Intestinal con buena correlación histológica.

          Translated abstract

          Barrett´s esophagus is an endoscopic diagnosis stablished when Intestinal Metaplasia is found histologically. We described the association of the type of Scamo columnar Junction (SCJ) described by Wallner et al and pit pattern (PP) classification by Toyoda et al suggestive of Intestinal Metaplasia using High Resolution endoscopy with Magnification and FICE. Salmon and red colored Tongues of columnar epithelium oriented to biopsy the esophagus. SCJ type GII was found in 45,09% and T3 PP in 60,86% of GII and 87,6% of GIII. Our results showed that type o SCJ helps and alert of the presence of Intestinal Metaplasia.

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          Most cited references26

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          The histologic spectrum of Barrett's esophagus.

          To define the histology of the columnarlined esophagus, we obtained esophageal biopsies from various levels with manometric control from 11 patients. There were three types of columnar epithelia above the lower esophageal sphincter: atrophic gastric-fundic-type epithelium with parietal and chief cells; junctional-type epithelium with cardiac mucous glands; and distinctive specialized columnar epithelium with a villiform surface, mucous glands and intestinal-type goblet cells. When present, specialized columnar epithelium was always the most proximal, and gastric fundic epithelium the most distal epithelium. Junctional epithelium was interposed between gastric fundic and specialized columnar or squamous epithelium. Four patients had unequivocal esophagitis in squamous epithelium, but its presence and severity did not correlate with inflammation in or length or type of distal columnar epithelium. Histoligic study of the columnar-lined esophagus demonstrated a spectrum of epithelial patterns. This heterogeneity helps to explain prior discrepant reports.
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            The columnar-lined esophagus, intestinal metaplasia, and Norman Barrett.

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              Enhanced magnification endoscopy: a new technique to identify specialized intestinal metaplasia in Barrett's esophagus.

              Specialized intestinal metaplasia (SIM) in Barrett's esophagus (BE) is not identifiable by standard endoscopy. Acetic acid instillation enhances the ability to detect columnar epithelium at the squamocolumnar union. Enhanced magnification endoscopy involves the combined use of magnification endoscopy with acetic acid. This study assessed the value of enhanced magnification endoscopy in detecting SIM in patients with BE. Patients undergoing endoscopic surveillance because of short segment BE without dysplasia underwent enhanced magnification endoscopy with 1.5% acetic acid instillation. Standard endoscopy was followed by magnification endoscopy and repeated after acetic acid spraying. Surface patterns were characterized prior to and after acetic acid spraying. The observed surface patterns were compared with histology results. Forty-nine patients, 9 women and 39 men, with a mean age of 50.5 years were studied. One was excluded because of unclear definition of the surface pattern. Enhanced magnification endoscopy detected 4 different mucosal surface patterns: I, round pits; II, reticular; III, villous; and IV, ridged. A total of 129 areas were examined. Standard endoscopy identified an endoscopic pattern in 1.5% of the areas, standard endoscopy and acetic acid in 8.5%, magnification endoscopy alone in 38%, and enhanced magnification endoscopy in all 129 endoscopic areas. The yields for detecting SIM according to endoscopic patterns were as follows: pattern I, 0%; II, 11% (odds ratio 0.5, p = 0.54); III, 87% (odds ratio 36, p = 0.001); and IV, 100% (odds ratio 14, p = 0.015). Enhanced magnification endoscopy is an accurate method of predicting SIM in BE. The simplicity of the technique and its ability to identify characteristic endoscopic patterns with outstanding clarity and resolution that correlate with histologic identification of specialized intestinal metaplasia make enhanced magnification endoscopy an excellent method for the evaluation of patients with BE.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                gen
                Gen
                Gen
                Sociedad Venezolana de Gastroentereología (Caracas )
                0016-3503
                March 2012
                : 66
                : 1
                : 20-24
                Affiliations
                [1 ] Universidad Central de Venezuela Venezuela
                [2 ] Universidad Central de Venezuela Venezuela
                [3 ] Universidad Central de Venezuela Venezuela
                [4 ] Clínica El Avila Venezuela
                Article
                S0016-35032012000100006
                38ad57be-3084-40dc-a59b-5a9f44341957

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0016-3503&lng=en

                Scamo Columnar Junction,Esophagogastric Junction,Barrett Esophagus,Chromoendoscopy,Virtual Chromoendoscopy,FICE,Unión Escamo Columnar,Metaplasia Intestinal en Esófago,Magnificación Endoscópica,Patrones de mucosa,Cromoscopia,Cromoscopia Virtual

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