Ubururu bwa metilene muri endosikopi y'urwungano ngogozi na kromoendosikopi

Amazi abiri y'ubururu ahuriye kuri molekile imwe, ariko nta bindi byinshi ahuriyeho. Mu cyumba cya endosikopi, umuganga atera ubururu bwa metilene buvanze n'amazi ku gahu k'imbere mu mara manini kugira ngo ahangiritse hadatumburutse harusheho kugaragara. Mu rugo, umuntu ashyira ibitonyanga by'ubururu biva mu icupa rigurwa mu iduka mu mazi, nk'umugenzo wo kwita ku mibereho myiza. Kwitiranya ibi byombi ni ukwibeshya ku cyo ari cyo, si ukwibeshya ku ngano ikoreshwa gusa: kimwe ni uburyo bwo kureba imbere mu mubiri hagamijwe gusuzuma, bukorwa hifashishijwe imiti yagenewe kwa muganga; ikindi ni igicuruzwa kigenewe abaguzi. Iyi ngingo isobanura ikoreshwa muri endosikopi, aho irangi ari igikoresho gifasha kureba, atari umuti uvura ibibonetse. Ku ishusho yagutse y'imikoreshereze yo kwa muganga yemejwe n'ikiri mu igerageza, soma incamake ku bururu bwa metilene mu buvuzi.

Gusiga irangi ku buso: irangi ryinjira mu turemangingo tuzima, si iryo kugaragaza ubuso gusa

Kureba imbere mu mubiri hifashishijwe irangi mu gihe cya endosikopi byitwa kromoendosikopi. Ubururu bwa metilene bukora icyo inzobere mu gusuzuma ingirangingo zita gusiga irangi ryinjira mu turemangingo tuzima cyangwa irangi ryinjizwa: uturemangingo tuzima twa epiteliyumu dufite ubushobozi bwo kwinjiza ibintu twinjiza irangi muri sitoplasime yatwo. Bityo, agahu k'imbere kazima gasigwaho irangi mu buryo bugereranyije bungana, mu gihe ahari uturemangingo twahindutse mu buryo budasanzwe, ububyimbirwe, cyangwa kanseri hinjiza irangi rike cyangwa hakagira ibara ritangana. Iryo tandukaniro rigaragaza imiterere y'agahu k'imbere ishobora kutagaragara mu mucyo wera wonyine, cyane cyane ahangiritse hadatumburutse.

Ubwo buryo butandukanye n'ubwa indigo carmine, irindi rangi risanzwe rikoreshwa muri kromoendosikopi. Indigo carmine yinjizwa ku rugero ruto cyane; yirekera mu twobo no mu miferege, igatuma imiterere y'ubuso igaragara kurushaho. Ubu ni uburyo bwo gusiga irangi kugira ngo hagaragare itandukaniro ku buso, aho kuba irangi ryinjira mu turemangingo tuzima. Incamake z'ubushakashatsi akenshi zishyira ayo marangi yombi mu cyiciro cya kromoendosikopi ikoresha irangi, bityo inyungu ivugwa kuri kromoendosikopi muri rusange ntiba ihita iba inyungu y'ubururu bwa metilene by'umwihariko.

Uburyo bwo kubikora busaba kwitondera utuntu twinshi. Muri kromoendosikopi ikoresha ubururu bwa metilene mu mara manini yose, ukora endosikopi atera irangi rifite ubukana bwa hafi 0.1%, agace ku kandi, akoresheje agati kayobora amazi. Ategereza hafi umunota kugira ngo irangi ryinjire, hanyuma akanyunyuza irirenze mbere yo gusuzuma. Ubukana bugera kuri hafi 0.5% bukoreshwa mu buryo bugamije agace runaka cyangwa bukoresha gukabya amashusho, ariko 0.1% ni bwo busanzwe bukoreshwa mu mara manini yose. Ibi byose bisaba ko amara aba yasukuwe neza cyane, kandi bikongeraho igihe cyo gukora. Izo mbogamizi ni zo zatumye hategurwa umuti usiga irangi mu mara manini mbere y'uko isuzuma ritangira.

Ikinini gisiga irangi giturutse imbere

Lumeblue, nanone yitwa methylene blue MMX, ni umuti w'ibinini bimira ukagenda urekura ibiwugize igihe kirekire. Wemewe muri EU nk'umuti ufasha gusuzuma, ugamije kurushaho kugaragaza ahangiritse mu mara manini no mu gice cya nyuma cyayo mu gihe cya kolonosikopi yo gushakisha ibibazo cyangwa gukurikirana uko umuntu ameze. Uruhushya rwo kuwushyira ku isoko rwo muri Kanama 2020 rusobanurwa mu ncamake ya EMA kuri uyu muti. Ingano ikoreshwa ni ibinini umunani bya 25 mg, byose hamwe bikaba 200 mg. Bimirwa uko byakabaye mu gihe cyo gusukura amara hakoreshejwe imiti ishingiye kuri PEG cyangwa nyuma yaho, ku mugoroba ubanziriza kolonosikopi, bigafatwa mu byiciro bikurikirana bya 3-3-2.

Imiterere y'ibikoresho bya MMX bifashe umuti ni yo shingiro ry'uko iki kinini cyateguwe. Igifuniko cyacyo kirihanganira aside yo mu gifu, kikangirika hafi ya pH 7 hafi y'igice cya nyuma cy'amara mato. Hanyuma kirekura irangi buhoro, ku buryo agahu k'imbere mu mara manini kamara igihe gahura n'irangi mu buryo bugereranyije bungana. Iyo kolonosikopi itangiye, amara manini aba yamaze gusigwaho irangi. Ibyo bituma Lumeblue iba umuti wo gusuzuma ugengwa n'amabwiriza, ufite ingano yagenwe n'ikoreshwa ryasobanuwe neza. Ibi bitandukanye haba n'umuti w'amazi uterwa n'ukora endosikopi, haba n'igicuruzwa icyo ari cyo cyose cyo mu iduka kigenewe imibereho myiza. Ubu bwoko butatu bugenewe intego zitandukanye kandi ntibushobora gusimburana; imiti y'amazi igurishwa mu maduka ivugwaho ukwawo mu nyoborabushobozi ku byunganira imirire n'ibirango.

Ibyabonetse mu bushakashatsi ku gutahura ahangiritse mu mara manini

Ibimenyetso bikomeye kurusha ibindi byerekeye ubururu bwa metilene by'umwihariko mu mara manini no mu gice cya nyuma cyayo biva mu igerageza rya MB-MMX ryo mu cyiciro cya III ryatangajwe na Repici na bagenzi be (PubMed 30742834): abarwayi 1,205 bari mu isuzuma ryo gushakisha ibibazo cyangwa mu gukurikirana uko bameze bashyizwe mu matsinda ku buryo bwa tombola, bahabwa 200 mg za MB-MMX cyangwa ikintu kitagira umuti. Igipimo cyo gutahura adenoma cyangwa carcinoma byemejwe no gusuzuma ingirangingo cyari 56.29% ugereranyije na 47.81%, ni ukuvuga itandukaniro nyakuri rya hafi amanota 8.5 y'ijanisha. Inyungu yagaragaye neza kurushaho ku hangiritse hatameze nka polipe no ku hangiritse hato cyane, ariko nta nyungu ifatika mu mibare yagaragaye ku hangiritse hanini cyangwa hameze nka polipe.

Ibimenyetso bya mbere ku gutera irangi ahanini biva mu gukurikirana indwara z'amara zirimo ububyimbirwe, aho kuba mu gusuzuma abantu bafite ibyago bisanzwe. Kiesslich na bagenzi be bashyize abarwayi 165 bari bamaze igihe kirekire bafite kolite irimo ibisebe mu matsinda ku buryo bwa tombola: bamwe bakorerwa kolonosikopi isanzwe, abandi kromoendosikopi ikoresha ubururu bwa metilene bwa 0.1%. Batahuye ahantu 32 hari imikurire mishya idasanzwe y'uturemangingo muri epiteliyumu, ugereranyije na 10 mu rindi tsinda (PubMed 12671882). Mu bushakashatsi bwa Marion na bagenzi be ku barwayi bafite kolite ijyanye na IBD, gufata utunyangingo two gusuzuma ahantu hatoranyijwe hifashishijwe gutera irangi na byo byatanze umusaruro uruta uwo gufata utunyangingo ahantu hatatoranyijwe (PubMed 18844620). Ibi ni ibisubizo byo gukurikirana kolite kandi bigomba kumvikana muri urwo rwego, hamwe n'ikiganiro cyihariye ku bururu bwa metilene n'indwara z'amara zirimo ububyimbirwe.

Isesengura rihuza ubushakashatsi bwinshi rishyigikira kromoendosikopi ikoresha irangi mu gutahura ahangiritse, nubwo ahanini rishingiye ku magerageza ya indigo carmine: incamake ya Cochrane yo muri 2016 yasanze amahirwe yo kubona nibura ahantu hamwe hari imikurire mishya idasanzwe y'uturemangingo yari menshi (PubMed 27056645). Isesengura rya Antonelli ryo muri 2022 ryahuje amagerageza icumi yagabanyije abitabiriye mu matsinda ku buryo bwa tombola ryatangaje ukwiyongera kugereranyije kwa hafi 20% mu gutahura adenoma (PubMed 35588768). Ibi bifasha gushyigikira igitekerezo muri rusange, ariko si gihamya yihariye y'ubururu bwa metilene.

Gutahura si ukuvura

Ibisubizo byose byavuzwe haruguru bireba kubona ahangiritse, si ukuvura kanseri. Lumeblue yemewe nk'umuti ufasha gusuzuma, kandi igerageza ryakoreshejwe mu kuyandikisha ryapimye ibipimo byo gutahura, aho gupima uko ikibyimba cyitabira umuti, uko indwara igaruka, cyangwa uko abarwayi bakomeza kubaho. Imvugo ya EMA ubwayo ishingiye ku gisabwa: gutahura neza kurushaho bishobora kugabanya ibyago bya kanseri niba ahangiritse hatahuwe hakuweho. Itandukaniro ry'amanota 8.5 mu gutahura ntirishobora kuvugwa nk'igabanuka rya 8.5% rya kanseri cyangwa impfu. Abasuzuma ibivugwa ku kuvura bagomba gutandukanya ibi neza, nk'uko bisobanurwa mu nyoborabushobozi itandukanya ibimenyetso byo muri laboratwari n'ibyo ku barwayi ku bururu bwa metilene na kanseri.

Ibimenyetso ku gice cyo hejuru cy'urwungano ngogozi biracyari bike

Mu muhogo wa Barrett, ubururu bwa metilene busiga ibara ry'ubururu ku ngirangingo zahindutse zigasa n'iz'amara. Ibi byatumye hatekerezwa gufata utunyangingo two gusuzuma mu duce twasizwe irangi, aho gufata ingero mu mpande enye hatabanje gutoranywa ahantu hagaragara ikibazo. Ibisubizo bya mbere byaturutse mu kigo kimwe byasaga n'ibitanga icyizere, ariko ubushakashatsi bwagutse kandi bugenzuwe neza kurushaho ntibwemeje inyungu mu gutahura ihinduka ridasanzwe ry'uturemangingo. Isesengura ryo muri 2009 ryahuje ubushakashatsi icyenda ryasanze nta nyongera ifatika mu mibare mu gutahura ingirangingo zahindutse zigasa n'iz'amara, ihinduka ridasanzwe ry'uturemangingo, cyangwa ihinduka ridasanzwe rikomeye ry'uturemangingo na kanseri yo mu ntangiriro, ugereranyije no gufata utunyangingo hakurikijwe gahunda ihamye (PubMed 19215918).

Amabwiriza yaje guhinduka. Amabwiriza agezweho ya ACG, ESGE, na ASGE yo gukurikirana umuhogo wa Barrett asaba kromoendosikopi ikoresha aside asetike cyangwa kromoendosikopi y'amashusho atunganywa n'ikoranabuhanga, buri gihe iherekejwe na gahunda ihamye ya Seattle yo gufata utunyangingo two gusuzuma. Ntabwo asaba ko gutera ubururu bwa metilene bisimbura gufata utunyangingo ahantu hatatoranyijwe. Kuvuga ko amabwiriza asaba kromoendosikopi rero ntibivuze ko asaba kromoendosikopi ikoresha ubururu bwa metilene.

Akabumbe k'ubururu munsi y'ahangiritse

Igice cy'ubururu kigaragara mu gihe cyo gukuraho agahu k'imbere hakoreshejwe endosikopi cyangwa cyo gukata munsi y'ako gahu ni ikindi kintu cya gatatu. Aha, guterura ahangiritse bikorwa n'amazi arimo umunyu cyangwa andi mazi aterwa munsi yaho kugira ngo hatandukanywe n'urukuta rw'imikaya. Hongerwamo ibitonyanga bike by'irangi ry'ubururu kugira ngo ubikora abone akabumbe k'amazi, aho gukata, n'urubibi rwo mu bujyakuzimu. Ibara ryerekana aho amazi yatewe yagiye. Nta cyo rivuga ku ihinduka ry'ingirangingo zigasa n'iz'ahandi cyangwa ku ihinduka ridasanzwe ry'uturemangingo. Intego yaryo ni ukurinda kwangiza ingirangingo mu gihe cyo gukata no gukuraho ahangiritse, ingingo iganirwaho hamwe n'indi mikoreshereze mu kubaga muri nyoborabushobozi ku kubaga n'uburyo bwo gusuzuma.

Icyitonderwa gifatika ku mutekano: urumuri hamwe n'irangi

Ubururu bwa metilene ni ikinyabutabire gituma urumuri rushobora gutera impinduka mu ngirangingo, kandi ubushakashatsi bubiri bwatumye abakora endosikopi babitekerezaho bitonze. Olliver na bagenzi be berekanye ko ubururu bwa metilene bwa 0.5% hamwe na endosikopi ikoresha urumuri rwera byongereye kwangirika kwa DNA mu gahu k'imbere k'umuhogo wa Barrett, mu bipimo bya comet; ariko irangi ridaherekejwe n'urumuri ntiryabikoze (PubMed 12907012). Davies na bagenzi be bongeye kubona iyo miterere mu mara manini: ubururu bwa metilene bwa 0.1% hamwe n'urumuri rwera byangije DNA y'uturemangingo tw'amara manini muri laboratwari no mu binyabuzima, mu gihe indigo carmine itabikoze (PubMed 17172595).

Icyo ibyo bimenyetso bivuga koko kiragarukira ku ngingo imwe: byerekanye kwangirika kwa DNA mu gihe gito, ntibyerekanye kanseri. Nta bushakashatsi bwerekanye ko kromoendosikopi ikoresha ubururu bwa metilene itera kanseri mu barwayi. Ariko, iyo bihujwe n'inyungu nke yagaragaye mu muhogo wa Barrett, icyo kimenyetso cyo kwangiza DNA cyashoboraga kwirindwa cyatumye irangi ridakundwa muri urwo rwego. Ibyo biri mu mpamvu amabwiriza ashyigikira ubundi buryo. Amakuru rusange ku gukoresha neza uyu muti n'ingaruka mbi zawo akusanyijwe mu nyandiko yerekeye umutekano n'ingaruka zitifuzwa.

Nyuma y'isuzuma: ibara ry'ubururu rirateganyijwe

Ubururu bwa metilene ni irangi rikomeye, kandi inkari n'umwanda bishobora kugira ibara ry'ubururu cyangwa icyatsi by'igihe gito nyuma y'isuzuma. Izi ni ingaruka z'irangi ziteganyijwe, aho kuba ibibazo byatewe n'isuzuma; inkari zishobora kugaragara nk'icyatsi kuko irangi ry'ubururu rivangana n'ibinyabutabire biha inkari ibara ry'umuhondo. Irangi rigeze ku ruhu rihasiga ibara ry'ubururu ry'igihe gito. Hari icyitonderwa kimwe kigomba kugumana n'aya makuru ahumuriza: ibara ry'ubururu rishya rikwiye ku ruhu hose, riherekejwe no guhumeka bigoranye cyangwa ihinduka mu kuba maso no kumenya ibibera umuntu, ritandukanye n'irangi rigaragara ku buso bw'uruhu. Risaba isuzuma ryihutirwa, aho gutegereza ko ibara rishira. Kandi hari icyitonderwa cya nyuma ku gusobanukirwa: ntukigere wemeza irangi ryakoreshejwe ushingiye ku ibara gusa. Kugaragara kw'ubururu ntikwemeza ko hakoreshejwe ubururu bwa metilene, kuko n'ibindi binyabutabire biha ingirangingo ibara ry'ubururu.

Iby'ingenzi wakwibuka

Tekereza ku byiciro bitatu bitandukanye: gusiga irangi ku buso bishingiye ku kuba uturemangingo twa epiteliyumu twinjiza irangi; imiti imirwa yo gusuzuma isiga irangi mu mara manini mbere y'isuzuma kandi ifite uruhushya rwo gushyirwa ku isoko; n'amazi afite ibara aterwa munsi y'agahu k'imbere kugira ngo yerekane aho gukata no gukuraho ahangiritse. Baza icyiciro ikivugwa kirimo, niba ibimenyetso byacyo byapimye gutahura cyangwa kuvura, n'ubwoko bw'umuti n'ubukana byageragejwe koko. Ubushakashatsi bushingirwaho mu gutandukanya ibyo byiciro buboneka mu bubiko bw'ubushakashatsi ku bururu bwa metilene.