Imethylene blue kwi-endoscopy yesisu namathumbu nakwi-chromoendoscopy

Ulwelo olubini oluluhlaza lwabelana ngemolekyuli enye, kodwa phantse akukho nto yimbi. Kwigumbi le-endoscopy, ugqirha utshiza imethylene blue exutywe yangaxinani kakhulu eludongeni lwangaphakathi lwekholoni ukuze kube lula ukubona izilonda ezithe tyaba. Ekhaya, umntu ucofa amathontsi aluhlaza kwibhotile ethengiselwa uluntu, ewagalela emanzini njengenxalenye yenkqubo yokuzikhathalela. Ukubhidanisa ezi zinto zimbini yimpazamo yokuqonda, kungekhona nje impazamo yedosi: enye yinkqubo yokubona ngaphakathi ukuze kuxilongwe, eyenziwa ngamalungiselelo onyango, enye yimveliso yomthengi. Eli nqaku licacisa icala le-endoscopy, apho idayi isisixhobo sokubona, ingelulo unyango lwento ebonwayo. Ukuze ufumane umfanekiso obanzi wokusetyenziswa kwayo kwezonyango okumiselweyo nokusalingwayo, jonga isishwankathelo semethylene blue kwezonyango.

Ukufakwa umbala kumphezulu: idayi efunxwa ziiseli eziphilayo, ingeyonto nje yokuqaqambisa

Ukubona ngaphakathi ngoncedo lwedayi ngexesha le-endoscopy kubizwa ngokuba yi-chromoendoscopy. Imethylene blue yenza oko iingcali zophando lwezifo zikubiza ngokuba kukufakwa umbala kwiiseli eziphilayo okanye ngokufunxa: iiseli eziphilayo ze-epithelium ezifunxayo zithatha idayi ziyifake kwi-cytoplasm yazo, ngoko inwebu yangaphakathi esempilweni ifumana umbala ophantse ulingane, ngoxa iindawo ezine-dysplasia, ezidumbileyo, okanye ezinomhlaza zifunxa idayi encinane okanye zifumana umbala ngamabala. Lo mahluko uveza ulwakhiwo lwenwebu yangaphakathi olunokungabonakali ngokukhanya okumhlophe kuphela, ingakumbi izilonda ezithe tyaba.

Le ndlela yokusebenza yahlukile kweye-indigo carmine, enye idayi eqhelekileyo ye-chromoendoscopy. I-indigo carmine phantse ayifunxwa; iqokelelana emingxunyeni nasemijelweni, iqaqambise ukuma komphezulu, nto leyo ekukufakwa kombala okwenza umahluko kunokufakwa kombala kwiiseli eziphilayo. Uphononongo ludla ngokuhlanganisa zombini ezi dayi phantsi kwe-chromoendoscopy esebenzisa idayi, ngoko inzuzo exeliweyo ye-chromoendoscopy ngokubanzi ayithethi ngokuzenzekelayo ukuba yinzuzo yemethylene blue ngokukodwa.

Inkqubo yokwenza oku ifuna unonophelo olukhulu. Kwi-chromoendoscopy yemethylene blue yekholoni yonke, ingcali ye-endoscopy itshiza idayi emalunga ne-0.1% kwicandelo ngalinye ngekhathetha, ilinde malunga nomzuzu ukuba ifunxwe, ize ifunxe isuse egqithisileyo ngaphambi kokuhlola. Ukuxinana ukuya kutsho malunga ne-0.5% kusetyenziswa kwiinkqubo ezijolise kwiindawo ezithile okanye ezandisa umfanekiso, kodwa i-0.1% yeyona nkqubo iqhelekileyo yekholoni yonke, kwaye yonke le nkqubo ifuna ukucocwa kwamathumbu okugqwesileyo kunye nexesha elongezelelweyo lokusebenza. Ezi ngxaki zakhuthaza ukwenziwa kolungiselelo olufaka umbala kwikholoni ngaphambi kokuba inkqubo iqale.

Ithebhulethi efaka umbala ngaphakathi

ILumeblue, ekwabizwa ngokuba yi-methylene blue MMX, lulungiselelo lwethebhulethi eginywayo ekhupha into esebenzayo ixesha elide, egunyaziswe kwi-EU njengesixhobo soxilongo sokuphucula ukubonakala kwezilonda zekholoni nerektamu ngexesha le-colonoscopy yokuhlola okanye yokubeka esweni. Ugunyaziso lokuyithengisa, olwaqala ngo-Agasti 2020, luchazwe kwisishwankathelo seyeza se-EMA. Idosi ziithebhulethi ezisibhozo ze-25 mg, zizonke ziyi-200 mg, eziginywa ziphelele ngexesha okanye emva kokulungiselelwa kwamathumbu okusekelwe kwi-PEG, ngokuhlwa ngaphambi kwe-colonoscopy, ngokulandelelana okunezikhewu kwe-3-3-2.

Isiseko se-MMX sisona sizathu solu yilo. Umaleko wayo wangaphandle uyamelana ne-asidi yesisu uze uqhekeke malunga ne-pH 7 kufutshane nesiphelo se-ileum, emva koko ikhuphe idayi kancinane ukuze inwebu yangaphakathi yekholoni ichanabeke kuyo ixesha elide nangendlela ephantse ilingane. Xa i-colonoscopy iqala, ikholoni sele ifakwe umbala. Oku kwenza iLumeblue ibe liyeza loxilongo elilawulwayo, elinedosi emiselweyo nenjongo yokusetyenziswa echaziweyo, nto leyo eyahlukileyo kwisinyibiliko esitshizwa yingcali ye-endoscopy nakuyo nayiphi na imveliso yokuzikhathalela ethengiselwa uluntu. La malungiselelo mathathu aphendula imibuzo eyahlukeneyo kwaye akanakusetyenziswa elinye endaweni yelinye; izinyibiliko ezithengiselwa uluntu zixoxwa ngokwahlukeneyo kwisikhokelo sezongezelelo neelebhile.

Okwafunyaniswa luphando lokufumanisa izilonda kwikholoni

Obona bungqina bunamandla obujolise ngokukodwa kwimethylene blue kwikholoni nerektamu buvela kulingo lwe-MB-MMX lwesigaba III oluchazwe nguRepici noogxa bakhe (PubMed 30742834): izigulana eziyi-1,205 ezazihlolwa okanye zibekwe esweni zabelwa ngokungakhethiyo ukufumana i-200 mg ye-MB-MMX okanye i-placebo. Ukufunyaniswa kwe-adenoma okanye i-carcinoma okuqinisekiswe ngovavanyo lwezicubu kwakuyi-56.29% xa kuthelekiswa ne-47.81%, umahluko othe ngqo omalunga ne-8.5 lamanqaku epesenti. Eyona nzuzo icacileyo yabonakala kwizilonda ezingafaniyo neepolyp nezincinane kakhulu, kungekho nzuzo ibalulekileyo kwezo zinkulu okanye zifana neepolyp.

Ubungqina bangaphambili bokutshizwa kwedayi buvela kakhulu ekubekweni esweni kwesifo samathumbu esidumbisayo kunasekuhlolweni kwabantu abanomngcipheko oqhelekileyo. UKiesslich noogxa bakhe babelwa izigulana eziyi-165 ezine-ulcerative colitis ekudala ikhona ngokungakhethiyo kwi-colonoscopy eqhelekileyo okanye kwi-chromoendoscopy yemethylene blue ye-0.1%, baza bafumana i-neoplasia eziyi-32 xa kuthelekiswa ne-10 ngaphakathi kwe-epithelium (PubMed 12671882). Kwi-colitis enxulumene ne-IBD, ii-biopsy ezijoliswe kwiindawo ezitshizwe ngedayi nazo zagqwesa ukuthathwa kweesampulu ngokungakhethiyo kulingo lukaMarion noogxa bakhe (PubMed 18844620). Ezi ziziphumo zokubekwa esweni kwe-colitis kwaye kufuneka ziqondwe kuloo meko, kunye nengxoxo ekhethekileyo yemethylene blue nesifo samathumbu esidumbisayo.

Uhlalutyo oludibanisa uphando olubanzi luxhasa i-chromoendoscopy esebenzisa idayi ekufumaniseni izilonda, nangona uninzi lwalo luvavanya i-indigo carmine: uphononongo lwe-Cochrane luka-2016 lwafumanisa amathuba aphezulu okufumana ubuncinane isilonda esinye se-neoplasia (PubMed 27056645), kwaye uhlalutyo luka-Antonelli luka-2022 oludibanisa amalingo alishumi anolwabiwo olungakhethiyo lwaxela ukwanda okuthelekisayo kokufunyaniswa kwe-adenoma okumalunga ne-20% (PubMed 35588768). Oku kuluncedo ekuqondeni le ndlela, kodwa akubobungqina obujolise ngokukodwa kwimethylene blue.

Ukufumanisa akulonyango

Isiphumo ngasinye esingentla sithetha ngokufumana izilonda, kungekhona ukunyanga umhlaza. ILumeblue igunyaziswe njengesixhobo soxilongo, kwaye ulingo lwayo lokubhaliswa lwalinganisa amazinga okufunyaniswa kwezilonda, kungekhona ukuphendula kwethumba kunyango, ukubuya kwalo, okanye ukusinda. Indlela i-EMA ekubeka ngayo oku inemiqathango: ukufunyaniswa okungcono kunokukhokelela kumngcipheko omncinane womhlaza ukuba izilonda ezifunyenweyo ziyasuswa. Umahluko wokufunyaniswa wezinga le-8.5 lamanqaku awunakuphinda uchazwe njengokuncipha komhlaza okanye kokufa nge-8.5%. Abafundi abavavanya amabango onyango kufuneka bawugcine ucacile lo mda, njengoko kuchazwa kwisikhokelo sokuthelekisa ubungqina baselabhoratri nobezigulana ngemethylene blue nomhlaza.

Ubungqina benxalenye ephezulu yenkqubo yokwetyisa bubuthathaka ngakumbi

Kwimeko yomqala kaBarrett, imethylene blue ifaka umbala oluhlaza kwi-metaplasia yamathumbu, nto leyo eyacebisa ukujolisa ii-biopsy kwiindawo ezifakwe umbala endaweni yokuthatha iisampulu kumacala amane ngaphandle kokujolisa kwindawo ebonwayo. Iziphumo zokuqala ezivela kwiziko elinye zabonakala zithembisa, kodwa uphando olukhulu nolulawulwe ngcono aluzange luqinisekise inzuzo ekufunyanisweni kwe-dysplasia. Uhlalutyo luka-2009 oludibanisa izifundo ezisithoba aluzange lufumane ukwanda okunentsingiselo ngokwezibalo ekufumaniseni i-metaplasia yamathumbu, i-dysplasia, okanye i-dysplasia ekumgangatho ophezulu nomhlaza wokuqala xa kuthelekiswa ne-biopsy elandela inkqubo ecwangcisiweyo (PubMed 19215918).

Izikhokelo zadlulela kwezinye iindlela. Izikhokelo zangoku ze-ACG, ESGE, ne-ASGE zokubekwa esweni komqala kaBarrett zicebisa i-chromoendoscopy esebenzisa i-acetic acid okanye i-chromoendoscopy eyenziwa ngomfanekiso we-elektroniki, isoloko ihamba kunye nenkqubo ecwangcisiweyo ye-biopsy yaseSeattle, kungekhona ukutshizwa kwemethylene blue endaweni yee-biopsy ezithathwa ngokungakhethiyo. Ngoko ukuthi izikhokelo zicebisa i-chromoendoscopy akuthethi ukuba zicebisa i-chromoendoscopy yemethylene blue.

Umqamelo oluhlaza ngaphantsi kwesilonda

Umaleko oluhlaza obonwa xa kusikwa kususwe inwebu yangaphakathi nge-endoscopy okanye xa kwahlulwa izicubu ezingaphantsi kwayo yenye indlela yesithathu eyahlukileyo. Apho, ukuphakanyiswa kubangelwa sisinyibiliko setyuwa okanye olunye ulwelo olutofwa ngaphantsi kwesilonda ukuze lwahlulwe kudonga lwesihlunu; kongezwa amathontsi ambalwa edayi eluhlaza ukuze umntu owenza inkqubo abone umqamelo, indawo yokwahlula izicubu, kunye nomda onzulu. Umbala uphawula apho ulwelo olutofwayo luye khona. Awuchazi nto nge-metaplasia okanye nge-dysplasia, kwaye injongo yawo kukhuseleko lomsebenzi wokusika kususwe izicubu. Lo mba uchazwa kunye nokunye ukusetyenziswa ngexesha lotyando kwisikhokelo sotyando neenkqubo zoxilongo.

Inqaku lokwenene ngokhuseleko: ukukhanya kunye nedayi

Imethylene blue yinto eyenza izicubu zichaphazeleke ngakumbi kukukhanya, kwaye izifundo ezibini zenza iingcali ze-endoscopy zilumke. UOlliver noogxa bakhe babonisa ukuba i-0.5% yemethylene blue kunye ne-endoscopy yokukhanya okumhlophe yandisa umonakalo we-DNA kwinwebu yangaphakathi yomqala kaBarrett kwiimvavanyo ze-comet, ngoxa idayi ngaphandle kokukhanya ingazange yenze njalo (PubMed 12907012). UDavies noogxa bakhe baphinda babonisa loo pateni kwikholoni: i-0.1% yemethylene blue kunye nokukhanya okumhlophe yonakalisa i-DNA yeeseli zekholoni kwiimvavanyo ezingaphandle komzimba nezingaphakathi emzimbeni, ngoxa i-indigo carmine ingazange yenze njalo (PubMed 17172595).

Ukutolika oku ngokunyanisekileyo kunomda: kuboniswe umonakalo we-DNA owenzeka ngoko nangoko, kungekhona umhlaza. Akukho sifundo sabonisa ukuba i-chromoendoscopy yemethylene blue ibangela umhlaza kwizigulana. Kodwa, xa kudityaniswa nenzuzo ebuthathaka kwimeko kaBarrett, olu phawu lomonakalo kwizinto zemfuza olunokuphetshwa lwenza le dayi ingakhethwa kuloo meko, nto leyo eyinxalenye yesizathu sokuba izikhokelo zikhethe ezinye iindlela. Ulwazi ngokuphathwa kwayo ngokubanzi nangeziphumo ezingathandekiyo luqokelelwe kwisalathiso sokhuseleko neziphumo ebezingalindelekanga.

Emva kwenkqubo: umbala oluhlaza ulindelekile

Imethylene blue yidayi enamandla, kwaye umchamo nelindle eziba luhlaza okwesibhakabhaka okanye luhlaza okwengca okwexeshana emva koko ziziphumo ezilindelekileyo zedayi, kungekhona iingxaki; umchamo unokubonakala uluhlaza okwengca kuba idayi eluhlaza okwesibhakabhaka ixubana nezinto ezinemibala etyheli emchameni. Idayi esikhumbeni ishiya umbala oluhlaza okwexeshana. Isilumkiso esinye sihlala sisebenza nangona oku kuthuthuzela: ulusu olusandul’ ukuba luhlaza emzimbeni wonke, lukhatshwa bubunzima bokuphefumla okanye lutshintsho kwinqanaba lokuqonda, yimeko eyahlukileyo kumbala obonakala nje kumphezulu, kwaye ifuna uvavanyo olungxamisekileyo, kungekhona ukulinda de umbala uphele. Kwaye isilumkiso sokugqibela malunga nokuqonda: ungaze ugqibe ngokuba yeyiphi idayi esetyenzisiweyo ngokujonga umbala kuphela. Ukubonakala kuluhlaza akuchongi imethylene blue, kuba nezinye izinto zifaka umbala oluhlaza kwizicubu.

Oko kufuneka ukukhumbule

Cinga ngeendidi ezintathu ezahlukeneyo: ukufakwa kombala kumphezulu okusebenzisa ukufunxa kweeseli ze-epithelium, amalungiselelo oxilongo aginywayo afaka umbala kwikholoni kwangaphambili phantsi kogunyaziso lokuthengisa, kunye nolwelo olunombala olungaphantsi kwenwebu yangaphakathi oluphawula indawo yokusika kususwe izicubu. Buza ukuba ibango lingena koluphi udidi, ukuba ubungqina balo bulinganise ukufunyaniswa okanye unyango, nokuba loluphi ulungiselelo nokuxinana okuye kwavavanywa ngokwenene. Izifundo ezixhasa lo mahluko zidweliswe kwithala lophando ngemethylene blue.