Accurate diagnosis and timely treatment of early
gastrointestinal lesions are essential to improve the prognosis and quality of life of patients.
Diagnostic method
Endoscopy is the core method in the diagnosis of early
gastrointestinal lesions. Common gastroscope and colonoscope can directly observe the mucosa of esophagus, stomach, duodenum and colorectum. High-resolution endoscopy can clearly show small lesions, such as early gastric cancer, which may show mucosal color changes, small protuberances or depressions. For some suspicious sites, staining endoscopy can play a role in detecting early lesions by spraying special dyes to make the lesions more obvious compared with normal mucosa, such as indigo carmine staining, which can highlight minor lesions in intestinal mucosa.
Magnifying endoscopy can further observe the fine structure of mucosa, such as the pit shape of gastric mucosa and the morphological changes of intestinal villi, which can provide a basis for judging the nature of the lesion. In addition, endoscopic ultrasonography is of great value in determining the depth of the lesion, which can distinguish whether the lesion is confined to the mucosa or has invaded deeper levels, which is of great significance for determining the treatment plan. For example, in the diagnosis of early esophageal cancer, endoscopic ultrasonography can help determine whether the tumor invades the muscular layer of the esophagus.
In addition to endoscopy, laboratory tests are also indispensable. Serological tests such as pepsinogen and carcinoembryonic antigen can be used as auxiliary means. The abnormal ratio of pepsinogen I to pepsinogen II may indicate the atrophy of gastric mucosa or early canceration, and the elevation of carcinoembryonic antigen may be related to gastrointestinal tumors, but the specificity is limited.
Endoscopic treatment
Endoscopic mucosal resection (EMR) is one of the important methods for the treatment of early gastrointestinal lesions. For small lesions confined to the mucosa, such as early gastric cancer or colonic polyps, EMR can completely remove the lesion tissue. During the operation, normal saline was injected at the bottom of the lesion to make the lesion bulge, and then the lesion was trapped and resected with a snare, which had less trauma and faster recovery.
Endoscopic submucosal dissection (ESD) is indicated for larger, more complex lesions. It can remove a large area of lesion tissue en bloc, and can ensure the integrity of the lesion resection, which is conducive to the accurate evaluation of the lesion by pathological examination. However, ESD operation is relatively difficult and requires experienced doctors. In the early cancer of esophagus, stomach, colon and other parts, ESD can achieve the effect of radical cure if the lesions meet the indications.
For some benign lesions, such as gastric varices, endoscopic sclerosing agent injection or ligation can be used to prevent bleeding. Endoscopic treatment methods such as duodenal papillary sphincterotomy are also used in the treatment of gastrointestinal lesions related to biliary and pancreatic diseases, which can alleviate obstruction and other problems.
The diagnosis and endoscopic treatment of
early gastrointestinal lesions are complementary to each other, accurate diagnosis provides the basis for reasonable endoscopic treatment, and the continuous development of endoscopic treatment technology brings better hope of cure for patients with early gastrointestinal lesions, which is helpful to improve the long-term survival rate and quality of life of patients.
