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Z Gastroenterol 2004; 42(5): 371-377
DOI: 10.1055/s-2004-812980
Originalarbeit

© Karl Demeter Verlag im Georg Thieme Verlag KG Stuttgart · New York

The Magnified Endoscopic View of Cardia-Type Mucosa

Der magnifikationsendoskopische Blick auf cardiatypische MukosaU. Peitz1 , M. Vieth2 , S. Kahl1 , A. Roessner2 , P. Malfertheiner1
  • 1Department of Gastroenterology, Hepatology, and Infectiology, Otto von Guericke University, Magdeburg, Germany
  • 2Institute of Pathology, Otto von Guericke University, Magdeburg, Germany
Further Information

Publication History

manuscript received: 6.11.2003

manuscript accepted: 6.2.2004

Publication Date:
10 May 2004 (online)

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Zusammenfassung

Hintergrund: Die Interpretation der Magnifikationsendoskopie im Hinblick auf die Metaplasie der ösophagogastralen Junktion (EGJ) ist noch kontrovers. Die Histologie von Arealen, die suspekt auf Barrett-Mukosa sind, deckt häufig nur cardiatypische Schleimhaut (CTM) auf. Ziel der Studie war es, die Oberflächenstruktur von CTM zu charakterisieren im Vergleich zu spezialisierter intestinaler Metaplasie (SIM) und Magenkorpusmukosa. Methoden: Eine Magnifikationsendoskopie wurde bei 52 Patienten mit normaler EGJ und 36 Patienten mit endoskopisch dargestelltem Zylinderepithelösophagus (CLE) durchgeführt. Biopsien für die Histologie wurden von der EGJ und CLE-Segmenten entnommen. In Fällen mit CLE wurden die Biopsien gezielt nach Methylenblaufärbung gewonnen. Ergebnisse: Ein gyriformes oder ovales Muster wurde bei allen Patienten mit einer normalen EGJ gefunden und entsprach histologisch CTM. Diese Muster waren leicht von den kleinen Grübchen der Magenkorpusmukosa zu unterscheiden. Ein gyriformes oder villöses Muster überwog im CLE, sowohl in Flächen mit CTM als auch mit SIM. Eine Methylenblaufärbung war häufiger in SIM als in CTM, aber war unzureichend spezifisch für SIM. Schlussfolgerungen: Auch wenn die Magnifikationsendoskopie eine eindeutige Differenzierung der CTM von Korpusmukosa erlaubt, so ist doch eine klare Abgrenzung zu SIM nicht möglich. Ergänzende Methoden zur Magnifikation wie Methylenblaufärbung und Kontrastanhebung mit Essigsäure sollten bezüglich der Differenzierung CTM versus SIM evaluiert werden.

Abstract

Background: The interpretation of magnification endoscopy regarding metaplasia of the esophagogastric junction (EGJ) is still controversial. Histology of areas endoscopically suspected of Barrett’s esophagus often reveals only cardia-type mucosa (CTM). The aim of this study was to characterize the surface structure of CTM by magnification endoscopy, in comparison with specialized intestinal metaplasia (SIM) and gastric corpus mucosa. Methods: Magnification endoscopy was performed in 52 patients with normal EGJ and 36 patients with columnar lined lower esophagus (CLE) on endoscopic examination. Biopsies for histology were obtained from EGJ and CLE segments. In cases with CLE, biopsies were targeted after methylene blue staining. Results: A gyriform or oval pattern was observed in all patients at the normal EGJ, histologically representing CTM. These patterns of CTM were easily discernible from the small pits of corpus mucosa. A gyriform or villous pattern was dominant in CLE, both in areas with CTM and those with SIM. Methylene blue staining was more frequent in SIM than in CTM, but was of insufficient specificity for SIM. Conclusions: Although magnification endoscopy allows one to differentiate CTM from gastric corpus mucosa, a clear distinction from SIM is not possible. Auxiliary methods that complement magnification endoscopy, like methylene blue staining and acetic acid contrast enhancement, should be evaluated regarding the differentiation between CTM and SIM.

Schlüsselwörter

Magnifikationsendoskopie - Cardia - Barett-Ösophagus - intestinale Metaplasia

Key words

Magnification endoscopy - cardia - Barett's esophagus - intestinal metaplasia

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Dr. med. Ulrich Peitz

Department of Gastroenterology, Hepatology and Infectiology, Otto von Guericke University

Leipziger Straße 44

39120 Magdeburg

Germany

Email: ulrich.peitz@medizin.uni-magdeburg.de

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