Endoscopic Diagnosis Of Chronic Gastritis By Image Enhancement Observation Method

Number:4a02c073

Name:Chen,Chia-Sheng

Professor:Wang,Ming-Shyan

Date:2015/05/21

Noriya Uedo, Gastrointestinal cancer (esophagus, stomach, large intestine) and endoscopic diagnosis and treatment

UICC, Osaka Medical Center for Cancer and Cardiovascular Disease

Outline

Basic policy Image enhanced endoscopy for diagnosis of chronic gastritis and

carcinoma Pathogenesis of gastric cancer

H. pylori-associated gastritis Chromoendoscopy Autofluorescence imaging Narrow band imaging

Basic policy

Many endoscopists, particularly in the West, considered the Japanese classification, with its numerous divisions for esophagus, stomach, and colon, to be a "botanical hobby", too complex for practical use. Lambert R, GIE 2003;58 (SUPPL)

I ain't looking to compete with you…classify you… All I really want to do is be friends with you Dylan B, 1964

Image Enhanced Endoscopy

Dye-based IEE 染料基於圖像增強內鏡 (chromoendoscopy 色素 ): Absorptive dye 吸收染料 Lugol’s solution 盧戈氏液 Methylene blue 亞甲藍

Contrast dye 造影劑 Indigo carmine 靛藍胭脂紅

Equipment-based IEE 設備基於圖像增強內鏡 : Optical 光學 Narrow band imaging 窄頻成像

Electronic 電子 Spectral estimation technology 光譜估計技術 : FICE富士智能色彩增強技術

Surface enhancement technology 表面增強技術 Autofluorescence imaging 自體螢光成像

Image Enhanced Endoscopy (tri-modal imaging):WLI,NBI,AFI

(三模態成像 )

Chronic gastritis as a cancer precursor

H. Pylori infection( 感染 )

↓

Acute gastritis( 急性胃炎 )

↓

Chronic gastritis( 慢性胃炎 )

↓

Atrophic gastritis( 萎縮性胃炎 )

↓

Intestinal metaplasia( 腸上皮化生 )

↓

Dysplasia( 發育異常 )

↓

Carcinoma

Relationship of gastroscopic feature to histological findings in gastritis and Helicobacter pylori infection in a general population sample

H. pylori (-) normal mucosa陰性反應正常的黏膜

Chronic atrophic gastritis慢性萎縮性胃炎

Sensitivity (%)Specificity 差異性 (%)Visible vessels 可見血管48 (26-70) 87 (84-90)Absence of rugae 67 (43-85) 85 (82-88)有無皺褶

Chromoendoscopic observations on extension and develoment of fundal gastritis and

intestinal metaplasia

Color difference in autofluorescence image自體螢光的顏色差異

0

0.1

0.2

480 580 680 780

Background mucosaGastric cancer

Fluorophores

• Mucosal thickening 黏膜增厚• Increased blood flow 增加血流

量 (Hb)• Different tissue structure 不

同的組織結構 etc…

Color difference of background mucosa in AFI imageAFI圖像背景粘膜色差

H. pyloriNegative(-)

Atrophic fundic gastritis 萎縮性胃

體胃炎

Diagnostic accuracy of green mucosa in gastric body by AFI for gastritis

由 AFI胃炎的診斷綠色胃體黏膜的準確性

Narrow band imaging,NBI窄頻成像

Xenon

Lamp

NBIfilter

RGB Rotary Filter

ON

OFF

400 500 600 nm

White light image(RGB broad band)

Hb absorption curve

Narrow band image

Diagnostic accuracy of LBC for histological IM

88 recorded images by three endoscopists

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