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一、关于内镜下活检取材由于正常情况下食管远端鳞状上皮移行为柱状上皮,因此内镜下准确进行部位定位对确定鳞状上皮是否被柱状上皮所取代极为重要。正常食管黏膜被覆鳞状上皮,内镜下呈灰红色。而胃贲门黏膜被覆柱状上皮呈桔红色,两者较易分辨。在距贲门口约2 cm以内、相当于食管穿越胸膈或食管下括约肌(LES)远端约1／2处,可见鳞状上皮和柱状上皮交界形成的不规则齿状线即所谓的“Z”线。内镜下喷洒Lugol 溶液,鳞状上皮因糖原碘染而可使“Z”线更加分明。“Z”线近端食管黏膜出现岛型或全周型分布酷似胃黏膜样的桔红色柔软黏膜,可能为Barrett食管(BE)病变,需取材确认。通常认为,上段食管出现的岛状桔红色区域多为异位胃黏膜,可能并非真正的BE,尽管该病变也会发生狭窄、食管蹼或食管炎,但一般不会发生癌变。
First, on the endoscopic biopsy material Since the distal esophageal squamous epithelium normally migrate to the columnar epithelium, endoscopic accurate positioning of the site to determine whether the squamous epithelium is replaced by the columnar epithelium is extremely important. Normal esophageal mucosa is covered with squamous epithelium, endoscopic grayish red. The gastric cardia mucosa coated columnar epithelium was orange, both easier to distinguish. About 2 cm away from the cardia, which is equivalent to the esophagus through the mediastinum or the distal esophageal sphincter (LES) about 1/2, shows the squamous epithelium and the columnar epithelium at the junction of the formation of irregular dentition called the “Z ”line. Endoscopic spray Lugol solution, squamous epithelium due to glycogen iodine dye and the “Z” line more clearly. The “Z” line of esophageal mucosa appeared island or perinatal distribution resembles gastric mucosa-like orange soft mucosa, which may be Barrett’s esophagus (BE) lesions need confirmation. It is generally believed that the upper segment of the esophagus appears mostly orange-red regional ectopic gastric mucosa, may not be true BE, although the disease will occur stenosis, esophageal web or esophagitis, but generally does not occur carcinogenesis.