胃黏膜肠上皮化生内镜诊断和分级的研究进展

Research progress in endoscopic diagnosis and grading of gastric mucosa intestinal metaplasia

摘要:

胃黏膜肠上皮化生（gastric intestinal metaplasia，GIM）是一种癌前组织病理学改变，其临床意义在于对胃癌发生风险的提示，有着大面积肠上皮化生背景的胃黏膜具有较高的癌变风险；另外，不完全型GIM与肠型胃癌相关。因此，GIM的内镜下监测对及时发现和管理早期胃癌具有重要意义。可操作的GIM胃癌风险评估分级提供了较好地针对肠上皮化生的胃黏膜癌变风险评估，但每次评估需要标准的活检，增加了损伤风险，GIM内镜分级在此背景下被提出，但其应用受内镜诊断GIM的准确性和临床使用的便捷性所制约。笔者分析了各类内镜下诊断技术对GIM的诊断效果，结合人工智能辅助识别GIM面积，综述EGGIM评分的可行性。

Abstract:

Gastric Intestinal Metaplasia (GIM) is a precancerous histopathological change. During the process of atrophic gastritis, intestinal epithelial cells replace the normal gastric mucosa. The clinical significance of intestinal metaplasia is to suggest the risk of gastric cancer. Gastric mucosa with extensive intestinal metaplasia background has a higher risk of gastric cancer. In addition, incomplete intestinal metaplasia is associated with intestinal-type gastric cancer, so endoscopic monitoring of intestinal metaplasia is of great significance for timely detection and management of early gastric cancer. Meanwhile, OLGIM Grading provides a better risk assessment of gastric mucosal cancer which targets intestinal metaplasia, but every assessment requires standard biopsy, which increases the risk of injury. In this context, the Endoscopic Grading of Gastric Intestinal Metaplasia was proposed, but its application is limited by the accuracy of endoscopic diagnosis of intestinal metaplasia and the convenience of clinical use. We analyzed the diagnostic effects of various endoscopic diagnostic techniques on intestinal metaplasia, combined with artificial intelligence assisted identification of intestinal metaplasia area, and reviewed the feasibility of EGGIM score.