Cromoendoscopia de ampliação de lesões polipóides gástricas 

C. Brandão, N. Fernandes, N. Mesquita, M. Dinis Ribeiro, R. Silva, H. L. Viana, L. Moreira Dias

 

Resumo

Objectivos: Determinar os padrões endoscópicos dos pólipos gástricos (PG) encontrados com a cromoendoscopia de ampliação e relacioná-los com os achados histológicos.

Material e Métodos: Dezanove doentes (H: 8; M:11) com PG (n=27) foram avaliados com o endoscópio de ampliação Q240Z® (Olympus Corporation) e cromoscopia com índigo carmim a 0,4%, após a remoção de muco com N-acetilcisteína. Após a observação dos padrões endoscópicos das lesões em ampliação (105x), os PG foram removidos e caracterizados histopatologicamente.

Resultados: Os achados histológicos foram: Gastrite Crónica (GC)-5; Metaplasia Intestinal(MI)-2; PG Inflamatório (INF)-12; PG Hiperplásico(H)-7; PG Adenomatoso(AD)-1. Os padrões endoscópicos dos PG foram classificados após a determinação da histologia. Identificados 4 padrões endoscópicos: Tipo I-redondo ou tubular; Tipo II-digitiforme ou "em feijão"; Tipo III-cerebriformes; Tipo IV-não estruturado. Em 19% dos pólipos (n=5) não foi possível identificar um padrão, por friabilidade intensa ou excesso de muco. Procedeu-se à relação dos padrões predominantes com a histologia: Tipo I: GC/MI; Tipo II: INF; Tipo III: H;Tipo IV:AD.

Conclusão: Estudos de validação e aplicabilidade clínica destes padrões poderão vir a definir a utilidade desta classificação na selecção de pólipos gástricos para polipectomia.

 

Summary

Aims: To define the endoscopic pit patterns of gastric polyps (GP) by magnification chromoendoscopy and correlate them with histopathologic findings.

Methods: A total of 19 patients (M: 8; F:11) with 27 GP were evaluated. The endoscopic procedure was performed with a magnification endoscope Q240Z® (Olympus Corporation) and consisted of applying a mucolytic agent followed by the spray by a 0,4% indigo carmine contrast dye spray. The pit patterns of the GP mucosa are then observed by using the maximum magnification (105x). All the polyps were then removed and sent for histopathological evaluation.

Results: The histological findings were: chronic gastritis (CG)-5; intestinal metaplasia (IM)-2; inflammatory GP (INF)-12; hyperplastic GP (H)-7; adenomatous GP (AD)-1. The GP endoscopic pit patterns were classified after histological characterisation. We identified four endoscopic patterns: Type I: round or tubular; Type II: finger-shaped or bean-like; Type III: brain-like; Type IV: unstructured.  Friability and mucous excess did not permit identification of an endoscopic pattern in 18,5% (n= 5) of the polyps. A correlation was established between the predominant pit patterns and the histological findings: Type I:CG/IM; Type II:INF; Type III:H; Type IV:AD.

Conclusion: GP endoscopic pit patterns can, in the future, aid in selecting patients for to polypectomy.

 

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Recebido para publicação: 13/07/2005

Aceite para publicação: 30/11/2005