指南共识丨欧洲胃肠内镜学会消化道内镜组织取样指南

2021-11-28 吴璋萱,杨力 消化界

一睹为快!

2021年9月,欧洲胃肠内镜学会(ESGE)发布了内镜下组织取样指南,在内镜检查中充分采集和处理组织样本是进行消化病理诊断的基础。本文就其中针对上消化道和下消化道内镜下组织取样的推荐意见翻译如下。

上消化道内镜组织取样

嗜酸性食管炎

  • 对于疑似嗜酸性食管炎的患者,应针对内镜黏膜异常的区域至少行6块活检,其中远端食管活检2~4块,近端食管2~4块。远端和近端活检标本应放在单独的容器中。(强推荐,低质量证据)

  • 对于组织学证实的嗜酸性食管炎患者,在初始治疗6~12周后进行活检,远端食管至少活检2~4块,近端食管2~4块,重点是内镜黏膜异常的区域。(弱推荐,非常低质量证据)

  • 不建议对治疗有应答并继续接受这些治疗的患者每年行内镜检查和组织学评估。(弱推荐,非常低质量证据)

胃食管反流病

  • 不推荐对内镜检查正常的患者进行活检以诊断胃食管反流病 (GERD)。(强推荐,低质量证据)

感染性食管炎

  • 仅在疑似念珠菌性食管炎且预期有治疗效果时才进行活检。当治疗出现耐药时,应针对白色斑块样病变活检以行组织学和真菌学分析。(弱推荐,低质量证据)

  • 对于疑似病毒性食管炎的患者,行6块活检,包括从食管溃疡的底部和边缘,以行组织学分析。(强推荐,低质量证据)

食管癌和早期肿瘤

  • 对于疑似进展期食管癌的患者,至少行6块活检。(强推荐,中等质量证据)

  • 对于可能适合内镜切除(巴黎分类 0-I、0-II)的病变,仅行1~2块靶向活检,以确定诊断,且不影响随后的内镜切除。(强推荐,低质量证据)

消化不良和胃炎

  • 对于疑似幽门螺杆菌感染的患者,从胃窦和胃体分别行2块活检,并行胃炎分期。(强推荐,低质量证据)

  • 将胃窦和胃体的活检标本放入单独的容器中。(强推荐,高质量证据)

胃底腺息肉

  • 不推荐对胃底腺息肉进行常规活检。(强推荐,低质量证据)

增生性息肉

  • 推荐对 > 10 mm的增生性息肉进行活检(或切除)。(强推荐,低质量证据)

腺瘤

  • 推荐对胃腺瘤进行活检,如果可通过内镜切除,则应切除胃腺瘤。(强推荐,中等质量证据)

胃癌

  • 对于疑似进展期胃癌的患者,至少进行 6 块活检。(强推荐,中等质量证据)

  • 对于可能适合内镜切除(巴黎分类 0-II)的病变,仅行1~2块靶向活检,以确定诊断并允许随后行内镜切除。(强推荐,低质量证据)

  • 对于疑似皮革胃的患者,应针对黏膜异常处至少进10块咬合活检。(弱推荐,低质量证据)

  • 对于活检阴性且持续怀疑皮革胃的患者,可重复行更广泛的活检。内镜超声 (EUS) 可用于指导胃最受影响部位的活检或细针穿刺/活检 (FNA/B)。(弱推荐,低质量证据)

乳糜泻

  • 对于疑似乳糜泻的患者,至少从十二指肠的不同部位行6块活检,包括从十二指肠球部取2块标本。活检标本可以收集在同一个容器中。(强推荐,高质量证据)

     

下消化道内镜组织取样

结肠炎

1.有结肠炎的临床和内镜下征象

  • 对于临床和内镜有结肠炎征象的患者,应进行分段活检(每个节段至少2块),并放置在不同的标本容器中(回肠、盲肠、升结肠、横结肠、降结肠和乙状结肠和直肠)。(弱推荐,低质量证据)

  • 建议病理医师了解结肠炎的内镜特征以及任何相关的临床数据。(弱推荐,低质量证据)

2.临床怀疑,但没有结肠炎的内镜征象

 

  • 当疑似显微镜下结肠炎时,从右半结肠(升结肠和横结肠)与左半结肠(降结肠和乙状结肠)各取2块活检,并放置在单独的容器中。(强推荐,低质量证据)

炎症性肠病

1.确诊炎症性肠病患者的监测内镜检查

  • 炎症性肠病患者监测内镜检查期间,采用全结肠色素内镜或虚拟色素内镜检查,并对任何可见的病变行靶向活检。(强推荐,中等质量证据)

  • 对于有结肠肿瘤、管状结肠、狭窄、持续治疗难治的炎症或原发性硬化性胆管炎病史的高危患者,色素内镜下靶向活检可结合沿结肠每间隔10 cm四象限非靶向活检应用。(弱推荐,低质量证据)

2.贮袋患者的监测内镜检查

 

  • 如果对贮袋异型增生进行监测,应对可见的异常进行活检,系统地从回肠输入袢、输出袢盲端、贮袋和肛门直肠套部每个部位至少活检2块。(强推荐,低质量证据)

3.已知溃疡性结肠炎的患者疾病活动或缓解的评估

 

  • 对于已知溃疡性结肠炎和内镜下炎症征象的患者,至少从受影响最严重的区域行2块活检,以评估活动性或是否有巨细胞病毒。(强推荐,低质量证据)

  • 对于已知溃疡性结肠炎且没有明显内镜下炎症征象的患者,先进的影像技术可能有助于确定靶向活检的区域,以评估组织学缓解是否有治疗效果。(强推荐,低质量证据)

4.确诊克罗恩病患者的疾病活动性评估

 

  • 不建议通过活检内镜下可见的炎症或外观正常的黏膜来评估已知克罗恩病患者的疾病活动性。(弱推荐,低质量证据)

潜在的癌前病变和结直肠癌

1.潜在的癌前病变

  • 对于经充分评估判断为癌前病变的结直肠息肉,应完全切除而不是活检。(强推荐,低质量证据)

2.疑为结直肠癌

 

  • 在内镜可行的情况下,对于潜在恶性的结直肠息肉,应整块切除而不是活检。如果当时内镜医师没有把握进行整块切除,则应仔细拍摄具有代表性的图像(而不是活检),以了解潜在的癌症病灶,并重新安排患者或转诊至经验丰富的中心。(强推荐,低质量证据)

  • 对于因深层浸润而无法行内镜切除的恶性病变,应仔细从潜在癌症病灶中行 6 块靶向活检。(强推荐,低质量证据)

  • 为降低污染和肿瘤播种的风险,操作过程中用于取样或切除潜在恶性病变的活检钳和圈套器不能重复使用,在可能的情况下,癌症取样应推迟至操作结束时实施。(强推荐,低质量证据)

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    2022-03-17 ms2000000182667314

    学习了

    0

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    2021-12-29 ms2000000182667314

    学习了

    0

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  7. [GetPortalCommentsPageByObjectIdResponse(id=1203425, encodeId=c7c512034251c, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a0a85549889, createdName=ms2000000182667314, createdTime=Thu Mar 17 12:48:15 CST 2022, time=2022-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1648451, encodeId=09ef1648451e6, content=<a href='/topic/show?id=2e3a832696b' target=_blank style='color:#2F92EE;'>#胃肠内镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83269, encryptionId=2e3a832696b, topicName=胃肠内镜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Mon May 30 22:03:51 CST 2022, time=2022-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1085492, encodeId=b09d108549264, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a0a85549889, createdName=ms2000000182667314, createdTime=Wed Dec 29 16:27:09 CST 2021, time=2021-12-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1262267, encodeId=29c8126226ec3, content=<a href='/topic/show?id=0ceb30545e0' target=_blank style='color:#2F92EE;'>#内镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30545, encryptionId=0ceb30545e0, topicName=内镜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Tue Nov 30 14:03:51 CST 2021, time=2021-11-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1339427, encodeId=bb48133942e5a, content=<a href='/topic/show?id=447663054f5' target=_blank style='color:#2F92EE;'>#欧洲#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63054, encryptionId=447663054f5, topicName=欧洲)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/PiajxSqBRaEKxsKDoOOFxGpMibw6lsQFUIicWt7kWGevkdgFhjiban1icD2JdIBmjVo7qX7aSlCSpiaia382nuLKiaI3Cg/132, createdBy=5c442500150, createdName=ms9474365431325850, createdTime=Tue Nov 30 14:03:51 CST 2021, time=2021-11-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464708, encodeId=91131464e084b, content=<a href='/topic/show?id=32e765e6591' target=_blank style='color:#2F92EE;'>#消化道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65765, encryptionId=32e765e6591, topicName=消化道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7b6e6676048, createdName=changhe715, createdTime=Tue Nov 30 14:03:51 CST 2021, time=2021-11-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1074989, encodeId=3adc10e498994, content=这个好,比较明确, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3c2b1620925, createdName=泽9867, createdTime=Mon Nov 29 09:45:31 CST 2021, time=2021-11-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1074956, encodeId=64eb10e4956e4, content=或病人有胸痛时,立即停药及时, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Mon Nov 29 07:06:44 CST 2021, time=2021-11-29, status=1, ipAttribution=)]
    2021-11-29 泽9867

    这个好,比较明确

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1203425, encodeId=c7c512034251c, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a0a85549889, createdName=ms2000000182667314, createdTime=Thu Mar 17 12:48:15 CST 2022, time=2022-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1648451, encodeId=09ef1648451e6, content=<a href='/topic/show?id=2e3a832696b' target=_blank style='color:#2F92EE;'>#胃肠内镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83269, encryptionId=2e3a832696b, topicName=胃肠内镜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Mon May 30 22:03:51 CST 2022, time=2022-05-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1085492, encodeId=b09d108549264, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a0a85549889, createdName=ms2000000182667314, createdTime=Wed Dec 29 16:27:09 CST 2021, time=2021-12-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1262267, encodeId=29c8126226ec3, content=<a href='/topic/show?id=0ceb30545e0' target=_blank style='color:#2F92EE;'>#内镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30545, encryptionId=0ceb30545e0, topicName=内镜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Tue Nov 30 14:03:51 CST 2021, time=2021-11-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1339427, encodeId=bb48133942e5a, content=<a href='/topic/show?id=447663054f5' target=_blank style='color:#2F92EE;'>#欧洲#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63054, encryptionId=447663054f5, topicName=欧洲)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/PiajxSqBRaEKxsKDoOOFxGpMibw6lsQFUIicWt7kWGevkdgFhjiban1icD2JdIBmjVo7qX7aSlCSpiaia382nuLKiaI3Cg/132, createdBy=5c442500150, createdName=ms9474365431325850, createdTime=Tue Nov 30 14:03:51 CST 2021, time=2021-11-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1464708, encodeId=91131464e084b, content=<a href='/topic/show?id=32e765e6591' target=_blank style='color:#2F92EE;'>#消化道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65765, encryptionId=32e765e6591, topicName=消化道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7b6e6676048, createdName=changhe715, createdTime=Tue Nov 30 14:03:51 CST 2021, time=2021-11-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1074989, encodeId=3adc10e498994, content=这个好,比较明确, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3c2b1620925, createdName=泽9867, createdTime=Mon Nov 29 09:45:31 CST 2021, time=2021-11-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1074956, encodeId=64eb10e4956e4, content=或病人有胸痛时,立即停药及时, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Mon Nov 29 07:06:44 CST 2021, time=2021-11-29, status=1, ipAttribution=)]
    2021-11-29 查查佳佳

    或病人有胸痛时,立即停药及时

    0

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