Mide Hastalıklarında Endoskopi ve Endoskopik Ultrasonografi (EUS)
Özet
Mide tümörlerinin ve subepitelyal lezyonların tanı ve yönetiminde endoskopik görüntüleme teknolojileri en kritik rolü oynamaktadır. Konvansiyonel endoskopi büyük kitleleri saptayabilirken, küçük ve düz lezyonlarda yetersiz kalabilmektedir. Bu sınırlılığı aşmak amacıyla geliştirilen kromoendoskopi ve bilgisayarlı sanal kromoendoskopi (NBI, FICE, I-SCAN) gibi ileri yöntemler, dokuyu boyayarak mukoza ve mikrovasküler yapıların kontrastını artırmakta ve erken evre mide kanserlerinin teşhisini kolaylaştırmaktadır. Hücresel düzeyde in vivo histopatolojik inceleme sunan konfokal lazer endomikroskopi (CLE) ise tanısal özgüllüğü en üst seviyeye taşımaktadır. Diğer taraftan, gastrointestinal duvar katmanlarının ve çevre yapıların net görüntülenmesini sağlayan endoskopik ultrasonografi (EUS), özellikle subepitelyal tümörlerin karakterizasyonunda altın standart kabul edilmektedir. EUS, lezyonun hangi tabakadan kaynaklandığını (örneğin lipom, pankreatik rest, karsinoid tümör veya mezenkimal kökenli GİST) belirleyerek malign potansiyel barındıran dokuları ayırt eder. Ayrıca EUS eşliğinde yapılan ince iğne aspirasyonu ve biyopsisi (EUS-FNA), kesin histopatolojik tanı ve immünohistokimyasal analiz imkanı sunarak hastaların tedavi stratejilerinin ve cerrahi ya da endoskopik rezeksiyon (EMR/ESD) gibi yönetim planlarının belirlenmesinde klinisyenlere rehberlik etmektedir.
Endoscopic imaging technologies play the most critical role in the diagnosis and management of gastric tumors and subepithelial lesions. While conventional endoscopy can detect large masses, it may fall short in identifying small and flat lesions. Advanced methods developed to overcome this limitation, such as chromoendoscopy and virtual chromoendoscopy (NBI, FICE, I-SCAN), enhance mucosal and microvascular contrast via optical or digital staining, facilitating the early detection of gastric cancer. Confocal laser endomicroscopy (CLE) maximizes diagnostic specificity by allowing cellular-level in vivo histopathological evaluation. On the other hand, endoscopic ultrasonography (EUS), providing clear visualization of gastrointestinal wall layers and adjacent structures, is considered the gold standard for characterizing subepithelial tumors. EUS identifies the layer of origin for lesions like lipomas, pancreatic rests, carcinoid tumors, or GISTs, separating benign conditions from those with malignant potential. Furthermore, combining EUS with fine-needle aspiration and biopsy (EUS-FNA) enables definitive histopathological diagnosis and immunohistochemical analysis, guiding clinicians in establishing proper treatment strategies and management workflows such as endoscopic mucosal resection or endoscopic submucosal dissection.
Referanslar
Kalayci T, Iliklerden UH. Emergency gastric cancer: Are there any differences between indications, morbidity, and mortality? Int Med. 2021;3(2):50-58. doi: 10.5455/im.46623.
Leung WK, Wu M-s, Kakugawa Y, et al. Screening for gastric cancer in Asia: current evidence and practice. The Lancet Oncology. 2008;9(3):279-287. doi: 10.1016/S1470-2045(08)70072-X
Tashiro A, Sano M, Kinameri K, et al. Comparing mass screening techniques for gastric cancer in Japan. World Journal of Gastroenterology. 2006;12(30):4873. doi: 10.3748/wjg.v12.i30.4873.
Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012;143(5):1179-1187. doi: 10.1053/j.gastro.2012.08.002
Zhang X, Li M, Chen S, et al. Endoscopic screening in Asian countries is associated with reduced gastric cancer mortality: a meta-analysis and systematic review. Gastroenterology. 2018;155(2):347-354. doi: 10.1053/j.gastro.2018.04.026. Epub 2018 Apr 30.
Coleman HG, Xie S-H, Lagergren J. The epidemiology of esophageal adenocarcinoma. Gastroenterology. 2018;154(2):390-405. doi: 10.1053/j.gastro.2017.07.046
Fitzgerald RC, Di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus. Gut. 2014;63(1):7-42. doi: 10.1136/gutjnl-2013-305372.
Shaheen NJ, Falk GW, Iyer PG, et al. ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Official Journal of the American College of Gastroenterology. 2016;111(1):30-50. doi: 10.1038/ajg.2015.322
Weusten B, Bisschops R, Coron E, et al. Endoscopic management of Barrett’s esophagus: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy. 2017;49(02):191-198. doi: 10.1055/s-0042-122140
Tada M, Katoh S, Kohli Y, et al. On the dye spraying method in colonofiberscopy. Endoscopy. 1976;8(02):70-74. doi: 10.1055/s-0028-1098379
Rex DK, Cutler CS, Lemmel GT, et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology. 1997;112(1):24-28. doi: 10.1016/s0016-5085(97)70214-2
Van Rijn JC, Reitsma JB, Stoker J, et al. Polyp miss rate determined by tandem colonoscopy: a systematic review. Official Journal of the American College of Gastroenterology. 2006;101(2):343-350. doi: 10.1111/j.1572-0241.2006.00390.x
Heresbach D, Barrioz T, Lapalus M, et al. Miss rate for colorectal neoplastic polyps: a prospective multicenter study of back-to-back video colonoscopies. Endoscopy. 2008;40(04):284-290. doi: 10.1055/s-2007-995618
Subramanian V, Ragunath K. Advanced endoscopic imaging: a review of commercially available technologies. Clinical Gastroenterology and Hepatology. 2014;12(3):368-376. doi: 10.1016/j.cgh.2013.06.015
Kaltenbach T, Sano Y, Friedland S, et al. American Gastroenterological Association (AGA) Institute technology assessment on image-enhanced endoscopy. Gastroenterology. 2008;134(1):327-340. doi: 10.1053/j.gastro.2007.10.062
Singh R, Chiam KH, Leiria F, et al. Chromoendoscopy: role in modern endoscopic imaging. Translational Gastroenterology and Hepatology. 2020;5:39. doi: 10.21037/tgh.2019.12.06
Qumseya BJ, Wang H, Badie N, et al. Advanced imaging technologies increase detection of dysplasia and neoplasia in patients with Barrett's esophagus: a meta-analysis and systematic review. Clinical Gastroenterology and Hepatology. 2013;11(12):1562-1570. doi: 10.1016/j.cgh.2013.06.017
Tholoor S, Bhattacharyya R, Tsagkournis O, et al. Acetic acid chromoendoscopy in Barrett's esophagus surveillance is superior to the standardized random biopsy protocol: results from a large cohort study (with video). Gastrointestinal Endoscopy. 2014;80(3):417-424. doi: 10.1016/j.gie.2014.01.041
Seewald S, Ang TL, Groth S, et al. Detection and endoscopic therapy of early esophageal adenocarcinoma. Current Opinion in Gastroenterology. 2008;24(4):521-529. doi: 10.1097/MOG.0b013e3282ff8b1f.
Zhao Z, Yin Z, Wang S, et al. Meta-analysis: The diagnostic efficacy of chromoendoscopy for early gastric cancer and premalignant gastric lesions. Journal of Gastroenterology and Hepatology. 2016;31(9):1539-1545. doi: 10.1111/jgh.13313
Gono K, Obi T, Yamaguchi M, et al. Appearance of enhanced tissue features in narrow-band endoscopic imaging. Journal of Biomedical Optics. 2004;9(3):568-577. doi: 10.1117/1.1695563
Singh R, Mei SCY, Sethi S. Advanced endoscopic imaging in Barrett's oesophagus: a review on current practice. World Journal of Gastroenterology. 2011;17(38):4271. doi: 10.3748/wjg.v17.i38.4271
Cho J-H, Jeon SR, Jin S-Y. Clinical applicability of gastroscopy with narrow-band imaging for the diagnosis of Helicobacter pylori gastritis, precancerous gastric lesion, and neoplasia. World Journal of Clinical Cases. 2020;8(14):2902. doi: 10.12998/wjcc.v8.i14.2902
Kara MA, Peters FP, Ten Kate FJ, et al. Endoscopic video autofluorescence imaging may improve the detection of early neoplasia in patients with Barrett's esophagus. Gastrointestinal Endoscopy. 2005;61(6):679-685. doi: 10.1016/s0016-5107(04)02577-5
Wanders LK, East JE, Uitentuis SE, et al. Diagnostic performance of narrowed spectrum endoscopy, autofluorescence imaging, and confocal laser endomicroscopy for optical diagnosis of colonic polyps: a meta-analysis. The Lancet Oncology. 2013;14(13):1337-1347. doi: 10.1016/S1470-2045(13)70509-6
Kiesslich R, Burg J, Vieth M, et al. Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo. Gastroenterology. 2004;127(3):706-713. doi: 10.1053/j.gastro.2004.06.050
Neumann H, Kiesslich R, Wallace MB, et al. Confocal laser endomicroscopy: technical advances and clinical applications. Gastroenterology. 2010;139(2):388-392. doi: 10.1053/j.gastro.2010.06.029
De Palma GD, Staibano S, Siciliano S, et al. In vivo characterisation of superficial colorectal neoplastic lesions with high-resolution probe-based confocal laser endomicroscopy in combination with video-mosaicing: a feasibility study to enhance routine endoscopy. Digestive and Liver Disease. 2010;42(11):791-797. doi: 10.1016/j.dld.2010.03.009
Wang TD, Friedland S, Sahbaie P, et al. Functional imaging of colonic mucosa with a fibered confocal microscope for real-time in vivo pathology. Clinical Gastroenterology and Hepatology. 2007;5(11):1300-11305. doi: 10.1016/j.cgh.2007.07.013
Su P, Liu Y, Lin S, et al. Efficacy of confocal laser endomicroscopy for discriminating colorectal neoplasms from non-neoplasms: a systematic review and meta-analysis. Colorectal Disease. 2013;15(1):1-12. doi: 10.1111/codi.12033
Papanikolaou IS, Fockens P, Hawes R, et al. Update on endoscopic ultrasound: how much for imaging, needling, or therapy? Scandinavian Journal of Gastroenterology. 2008;43(12):1416-1424.
Landi B, Palazzo L. The role of endosonography in submucosal tumours. Best Practice and Research Clinical Gastroenterology. 2009;23(5):679-701. doi: 10.1080/00365520701737252.
Nickl N. Endoscopic approach to gastrointestinal stromal tumors. Gastrointestinal Endoscopy Clinics. 2005;15(3):455-466. doi: 10.1016/j.giec.2005.04.001
Chak A. EUS in submucosal tumors. Gastrointestinal Endoscopy. 2002;56(4):43-48. doi: 10.1016/s0016-5107(02)70085-0.
Polkowski M, Butruk E. Submucosal lesions. Gastrointestinal Endoscopy Clinics. 2005;15(1):33-54. doi: 10.1016/j.giec.2004.07.005.
Rosch T, Kapfer B, Will U, et al. Endoscopic ultrasonography. Accuracy of endoscopic ultrasonography in upper gastrointestinal submucosal lesions: a prospective multicenter study. Scandinavian Journal of Gastroenterology. 2002;37(7):856-862.
Hwang JH, Rulyak SD, Kimmey MB. American Gastroenterological Association Institute technical review on the management of gastric subepithelial masses. Gastroenterology. 2006;130(7):2217-2228. doi: 10.1053/j.gastro.2006.04.033
Dias AR, Azevedo BC, Alban LBV, et al. Gastric neuroendocrine tumor: review and update. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo). 2017;30:150-154. doi: 10.1590/0102-6720201700020016
