tailieunhanh - Practical Pediatric Gastrointestinal Endoscopy - part 10

Ở những bệnh nhân lâu dài nhiễm H. pylori, chromoendoscopy với Congo đỏ sẽ thể hiện teo dạ dày là một lĩnh vực nhuộm tiêu cực đối với nền màu xanh / đen tối của niêm mạc bình thường của đáy dạ dày và cơ thể. Chromoendoscopy với màu đỏ phenol sẽ xác định mức độ thực dân | 190 CHAPTER 9 Fig. Endoscopic view of Barrett s esophagus a plain close view b close view after methylene blue staining c with the endoscope slightly withdrawn a small area of negative staining can be seen in the uppermost part of the lesion top biopsy of this area showed moderate-grade dysplasia. H. pylori infection and related disorders In patients with long-lasting H. pylori infection chromoendoscopy with Congo red will demonstrate gastric atrophy as an area of negative staining on the dark blue black background of the normal mucosa of the gastric fundus and body. Chromoendoscopy with phenol red will define the extent of H. pylori colonization in the stomach by producing a yellow staining throughout the affected gastric mucosa which is alkalinized by urease. Celiac disease Staining with methylene blue even without preparation of the duodenal mucosa makes the typical mosaic pattern more prominent and crisp emphasizing the coarse cobblestone appearance of the celiac mucosa that may not be evident at standard endoscopy Fig. . Immersion chromoendoscopy - . 1 methylene blue spray combined with magnification obtained by CHROMOENDOSCOPY 191 Fig. Endoscopic view of the distal duodenum in a patient with celiac disease and total villous atrophy. a A very mild scalloping of Kerckring s folds can be seen but there is no clear evidence of mucosal atrophy b even without preparation of the mucosa the mosaic pattern typical of gluten-sensitive enteropathy is clearly seen following methylene blue spray. immersion of the endoscope tip - can amplify the difference between the mosaic pattern due to villous atrophy and the normal duodenal mucosa where villi can be clearly seen along the duodenal folds Fig. . Polyposis syndromes In patients with FAP small flat duodenal adenomas will be easily identified as negative-staining plaques following methylene blue spray Fig. . In colonic polyposis indigo carmine staining can help identify small superficial lesions

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