I-methylene blue ku-endoscopy yamathumbu nesisu naku-chromoendoscopy

Uketshezi olubili oluluhlaza okwesibhakabhaka lune-molecule efanayo kodwa cishe akukho okunye olufana ngakho. Egumbini le-endoscopy, udokotela ufafaza i-methylene blue ehlanjululwe ngamanzi olwelwesini lwekholoni ukuze kube lula ukubona izilonda eziyisicaba. Ekhaya, umuntu ukhama amaconsi aluhlaza okwesibhakabhaka ebhodleleni elithengiswa esitolo, awafake emanzini njengengxenye yomkhuba wokuzinakekela. Ukudidanisa lokhu okubili kuyiphutha lokuqonda, hhayi nje iphutha lomthamo: okunye kuyinqubo yokwenza izicubu zibonakale ukuze kuhlonzwe izinkinga, eyenziwa ngezinto ezilungiselelwe ukusetshenziswa kwezokwelapha; okunye kungumkhiqizo wabathengi. Lesi sihloko sichaza uhlangothi lwe-endoscopy, lapho udayi uyithuluzi lokubona, hhayi ukwelapha lokho okubonwayo. Ukuze uthole isithombe esibanzi sokusetshenziswa kwezokwelapha osekuqinisekisiwe nokusahlolwa, bheka ukubuka konke kwe-methylene blue kwezokwelapha.

Ukufaka umbala ebusweni bezicubu: udayi omuncwa amaseli aphilayo, hhayi ipeni lokugqamisa

Ukwenza izicubu zibonakale ngosizo lukadayi ngesikhathi se-endoscopy kubizwa ngokuthi yi-chromoendoscopy. I-methylene blue yenza lokho ongoti bezifo abakubiza ngokuthi ukufaka umbala ngokumuncwa amaseli aphilayo: amaseli aphilayo e-epithelium anekhono lokumunca angenisa udayi ku-cytoplasm yawo. Ngenxa yalokho, ulwelwesi lwamafinyila olunempilo lufakwa umbala ocishe ulingane, kuyilapho izindawo ezine-dysplasia, ezivuvukele noma ezinomdlavuza zimunca udayi omncane noma zifakwa umbala ngokungalingani. Lo mehluko wembula ukwakheka kolwelwesi lwamafinyila okungase kungabonakali ngokukhanya okumhlophe kuphela, ikakhulukazi izilonda eziyisicaba.

Le ndlela ihlukile kweye-indigo carmine, omunye udayi ojwayelekile we-chromoendoscopy. I-indigo carmine ayimuncwa cishe nhlobo; iqoqana emigodini nasemiseleni, yenze ukwakheka kobuso bezicubu kugqame. Lokhu kuwukufaka umbala okwenza umehluko ubonakale, kunokufaka umbala ngokumuncwa amaseli aphilayo. Ukubuyekezwa kocwaningo kuvame ukuhlanganisa bobabili odayi ngaphansi kwe-chromoendoscopy esebenzisa udayi, ngakho inzuzo ebikiwe ye-chromoendoscopy iyonke ayiyona ngokuzenzakalelayo inzuzo ye-methylene blue ngokukhethekile.

Indlela yokwenza le nqubo idinga ukunakekela okukhulu. Ku-chromoendoscopy yekholoni lonke esebenzisa i-methylene blue, udokotela we-endoscopy ufafaza udayi ocishe ube ngu-0.1% engxenyeni ngayinye nge-catheter, alinde cishe umzuzu ukuze umuncwe, bese emunca osalayo ngaphambi kokuhlola. Ukugxila kukadayi okufinyelela cishe ku-0.5% kuyasetshenziswa ezinqubweni eziqondiswe ezindaweni ezithile noma ezikhulisa isithombe, kodwa u-0.1% uyindlela evamile yokuhlola ikholoni lonke. Yonke le nqubo idinga ukuhlanzwa kwamathumbu okuhle kakhulu kanye nesikhathi esengeziwe sokusebenza. Lezi zingqinamba zagqugquzela ukwakhiwa komkhiqizo ofaka umbala ekholoni ngaphambi kokuba inqubo iqale.

Ithebhulethi efaka umbala ngaphakathi

I-Lumeblue, ebizwa nangokuthi i-methylene blue MMX, iyithebhulethi ephuzwa ngomlomo ekhipha umuthi isikhathi eside. Igunyazwe e-EU njengomuthi wokuxilonga othuthukisa ukubonakala kwezilonda zekholoni nengxenye yokugcina yethumbu elikhulu ngesikhathi se-colonoscopy yokuhlolela izifo noma yokuqapha. Ukugunyazwa kwayo ukumakethwa kusukela ngo-August 2020 kuchazwe ekubukeni konke komuthi kwe-EMA. Umthamo ngamaphilisi ayisishiyagalombili angu-25 mg, esewonke angu-200 mg, agwinywa ephelele ngesikhathi noma ngemva kokulungiselela amathumbu nge-PEG kusihlwa ngaphambi kwe-colonoscopy, ngokulandelana okuhlukanisiwe kwe-3-3-2.

Isisekelo se-MMX siyisici esiyinhloko salo mklamo. Ungqimba lwaso lwangaphandle alumuncwa yi-asidi yesisu futhi luwohloka lapho i-pH icishe ibe ngu-7 eduze nengxenye yokugcina ye-ileum. Ngemva kwalokho, lukhipha udayi kancane ukuze ulwelwesi lwamafinyila lwekholoni luchayeke kudayi isikhathi eside nangokulinganayo. Lapho i-colonoscopy iqala, ikholoni selifakwe umbala. Lokho kwenza i-Lumeblue ibe umuthi wokuxilonga olawulwayo, onomthamo obekiwe kanye nokusetshenziswa okuchazwe ngokucacile. Lokhu kuhlukile kokubili esixazululweni esifafazwa udokotela we-endoscopy nakunoma yimuphi umkhiqizo wokuzinakekela othengiswa esitolo. Lezi zinhlobo ezintathu ziphendula imibuzo ehlukene futhi azinakusetshenziswa ngokushintshana; izixazululo ezithengiswa ezitolo zixoxwa ngokwehlukana kumhlahlandlela wezithasiselo nokulebula.

Okutholwe ucwaningo lokutholwa kwezilonda ekholoni

Ubufakazi obuqine kakhulu obuqondene ne-methylene blue ekholoni nasengxenyeni yokugcina yethumbu elikhulu buvela esivivinyweni sesigaba III se-MB-MMX esibikwe ngu-Repici nozakwabo (PubMed 30742834): iziguli ezingu-1,205 ezazihlolelwa izifo noma ziqashwa zabelwa ngokungahleliwe ukuthola i-MB-MMX engu-200 mg noma i-placebo. Ukutholwa kwe-adenoma noma kwe-carcinoma okuqinisekiswe ngokuhlolwa kwezicubu kwakungu-56.29% uma kuqhathaniswa no-47.81%, umehluko ophelele wamaphuzu ephesenti acishe abe ngu-8.5. Inzuzo yayicace kakhulu ezilondeni ezingafani nama-polyp nasezilondeni ezincane kakhulu, kanti kwakungekho nzuzo ebalulekile ngokwezibalo kwezinkulu noma ezifana nama-polyp.

Ubufakazi bangaphambilini bokufafaza udayi buvela kakhulu ekuqapheni izifo zamathumbu ezivuvukalayo kunasekuhloleleni izifo abantu abanobungozi obujwayelekile. U-Kiesslich nozakwabo babelwa ngokungahleliwe iziguli ezingu-165 ezase zihlale isikhathi eside zine-ulcerative colitis ukuba zithole i-colonoscopy evamile noma i-chromoendoscopy ene-methylene blue engu-0.1%, bathola izindawo zokukhula okungajwayelekile ngaphakathi kwe-epithelium ezingu-32 uma kuqhathaniswa nezingu-10 (PubMed 12671882). Ku-colitis ehlobene ne-IBD, ukuthathwa kwezicubu ezindaweni eziqondiwe ngosizo lokufafaza udayi nakho kwaba ngcono kunokuthatha amasampula ngokungahleliwe esivivinyweni sika-Marion nozakwabo (PubMed 18844620). Le miphumela iqondene nokuqapha i-colitis futhi kufanele iqondwe kulowo mongo, kanye nengxoxo eqondiswe ku-methylene blue nesifo samathumbu esivuvukalayo.

Ukuhlaziywa okuhlanganisa izifundo eziningi kubonisa inzuzo ye-chromoendoscopy esebenzisa udayi ekutholeni izilonda, kodwa kuvame ukuhlola i-indigo carmine: ukubuyekezwa kwe-Cochrane kwango-2016 kwathola amathuba aphezulu okuthola okungenani isilonda esisodwa sokukhula okungajwayelekile kwezicubu (PubMed 27056645), kanti ukuhlaziywa kuka-Antonelli kwango-2022 kwezivivinyo eziyishumi ezabelwe ngokungahleliwe kwabika ukwanda okuhlobene kokutholwa kwe-adenoma okucishe kube ngu-20% (PubMed 35588768). Lokhu kuyasiza ekuqondeni umqondo, kodwa akubona ubufakazi obuqondene ne-methylene blue.

Ukuthola akukhona ukwelapha

Yonke imiphumela engenhla imayelana nokuthola izilonda, hhayi ukwelapha umdlavuza. I-Lumeblue igunyazwe njengomuthi wokuxilonga, futhi isivivinyo sayo sokubhaliswa salinganisa amazinga okutholwa kwezilonda, hhayi ukusabela kwezicubu zomdlavuza ekwelashweni, ukuphinda kwazo noma ukusinda kweziguli. Indlela i-EMA ngokwayo ekubeka ngayo inombandela: ukutholwa okungcono kungase kwehlise ubungozi bomdlavuza uma izilonda ezitholakele zisuswa. Umehluko wamaphuzu angu-8.5 ekutholweni kwezilonda awunakuchazwa kabusha njengokwehla komdlavuza noma kokufa ngo-8.5%. Abafundi abahlola izimangalo zokwelapha kufanele bawugcine ucacile lo mngcele, njengoba kuchaza umhlahlandlela wobufakazi baselabhorethri uma buqhathaniswa nobeziguli mayelana ne-methylene blue nomdlavuza.

Ubufakazi bengxenye engenhla yomgudu wokugaya ukudla bubuthakathaka kakhulu

Esimweni esibizwa ngokuthi umminzo ka-Barrett, i-methylene blue ifaka umbala oluhlaza okwesibhakabhaka ezicubwini eziguquke zafana nezamathumbu. Lokhu kwasikisela ukuthi kuthathwe amasampula ezicubu ezindaweni ezifakwe umbala esikhundleni sokuthatha amasampula ezinhlangothini ezine ngaphandle kokubona indawo eqondiwe. Imiphumela yokuqala yezifundo zesikhungo esisodwa yayibonakala ithembisa, kodwa izifundo ezinkulu nezilawulwe kangcono azizange ziqinisekise inzuzo ekutholeni i-dysplasia. Ukuhlaziywa kwango-2009 okuhlanganisa izifundo eziyisishiyagalolunye akutholanga ukwanda kokutholwa okubalulekile ngokwezibalo kwe-metaplasia yamathumbu, i-dysplasia, noma i-dysplasia yezinga eliphezulu nomdlavuza osaqala uma kuqhathaniswa nokuthathwa kwezicubu ngendlela ehlelekile (PubMed 19215918).

Imihlahlandlela yashintshela kwezinye izindlela. Imihlahlandlela yamanje ye-ACG, ESGE ne-ASGE yokuqapha umminzo ka-Barrett itusa i-chromoendoscopy esebenzisa i-acetic acid noma i-chromoendoscopy ebonakalayo eyenziwa nge-elekthronikhi, njalo ihambisana nendlela ehlelekile ye-Seattle yokuthatha amasampula ezicubu. Ayitusi ukufafaza i-methylene blue esikhundleni sokuthatha amasampula ezicubu ngokungahleliwe. Ngakho ukusho ukuthi imihlahlandlela itusa i-chromoendoscopy akusho ukuthi itusa i-chromoendoscopy esebenzisa i-methylene blue.

Ungqimba oluhlaza okwesibhakabhaka ngaphansi kwesilonda

Ungqimba oluhlaza okwesibhakabhaka olubonakala ngesikhathi sokususwa kolwelwesi lwamafinyila nge-endoscopy noma sokuhlukaniswa kwezicubu ezingaphansi kwalo luwumqondo wesithathu ohlukile. Lapho, ukuphakanyiswa kwesilonda kwenziwa amanzi anosawoti noma olunye uketshezi olujovwa ngaphansi kwaso ukuze luhlukaniswe nodonga lwemisipha. Kufakwa amaconsi ambalwa kadayi oluhlaza okwesibhakabhaka ukuze owenza inqubo abone ungqimba oluphakamisayo, indawo yokuhlukanisa izicubu kanye nomngcele ojulile. Umbala ukhombisa lapho uketshezi lomjovo luye khona. Awusho lutho nge-metaplasia noma i-dysplasia, futhi inhloso yawo ukuphepha kokuhlukaniswa nokususwa kwezicubu. Lesi sihloko sihlanganiswe nezinye izindlela zokusetshenziswa ekuhlinzeni kumhlahlandlela wokuhlinza nezinqubo zokuxilonga.

Isexwayiso sangempela sokuphepha: ukukhanya kanye nodayi

I-methylene blue iyinto ezwela ukukhanya futhi evuselelwa yikho, futhi izifundo ezimbili zenza odokotela be-endoscopy baqaphele. U-Olliver nozakwabo babonisa ukuthi i-methylene blue engu-0.5% kanye ne-endoscopy yokukhanya okumhlophe kwandisa ukulimala kwe-DNA olwelwesini lwamafinyila luka-Barrett ekuhlolweni kwe-comet, kuyilapho udayi ngaphandle kokukhanya ungakwenzanga lokho (PubMed 12907012). U-Davies nozakwabo baphinde bathola lokhu ekholoni: i-methylene blue engu-0.1% kanye nokukhanya okumhlophe kwalimaza i-DNA yamaseli ekholoni elabhorethri nasezintweni eziphilayo, kuyilapho i-indigo carmine ingakwenzanga lokho (PubMed 17172595).

Ukuhumusha lokhu ngobuqotho kufanele kube nomkhawulo: kwaboniswa ukulimala kwe-DNA okwenzeka ngokushesha, hhayi umdlavuza. Akukho sifundo esabonisa ukuthi i-chromoendoscopy esebenzisa i-methylene blue ibangela umdlavuza ezigulini. Kodwa uma kuhlanganiswa nobufakazi obubuthakathaka benzuzo esimweni sika-Barrett, lolu phawu lokulimala kwezinto zofuzo olungagwemeka lwenza udayi ungathandeki lapho. Lokhu kuyingxenye yesizathu sokuthi imihlahlandlela ikhethe ezinye izindlela. Ulwazi olujwayelekile lokuphatha udayi nemiphumela engemihle luqoqwe encwadini yokubhekisela yokuphepha nemiphumela engemihle.

Ngemva kwenqubo: kulindeleke umbala oluhlaza okwesibhakabhaka

I-methylene blue ingudayi onamandla, futhi umchamo noma indle eluhlaza okwesibhakabhaka noma eluhlaza okotshani okwesikhashana ngemva kwenqubo kuyimiphumela elindelekile kadayi, hhayi izinkinga zenqubo. Umchamo ungabonakala uluhlaza okotshani ngoba udayi oluhlaza okwesibhakabhaka uhlangana nezinto ezinikeza umchamo umbala ophuzi. Udayi esikhunjeni ushiya umbala oluhlaza okwesibhakabhaka wesikhashana. Kukhona isexwayiso esisasebenza naphezu kwalokhu kuqinisekiswa: isikhumba esiqala ukuba luhlaza okwesibhakabhaka umzimba wonke, okuhambisana nobunzima bokuphefumula noma ukuguquka kwezinga lokuphaphama, kuyisimo esihlukile kumbala obonakala ebusweni besikhumba futhi kudinga ukuhlolwa okuphuthumayo, hhayi ukulinda ukuthi umbala uphele. Nesexwayiso sokugcina sokuqonda: ungalokothi uphethe ngokuthi yimuphi udayi osetshenzisiwe ngokubheka umbala kuphela. Ukubonakala kuluhlaza okwesibhakabhaka akukhombi i-methylene blue, ngoba nezinye izinto zifaka izicubu lowo mbala.

Okufanele ukukhumbule

Cabanga ngezigaba ezintathu ezihlukene: ukufaka umbala ebusweni bezicubu ngokusebenzisa ukumuncwa amaseli e-epithelium, imikhiqizo yokuxilonga ephuzwa ngomlomo efaka umbala ekholoni kusengaphambili ngaphansi kokugunyazwa ukumakethwa, kanye noketshezi olufakwe umbala ngaphansi kolwelwesi lwamafinyila olukhombisa indawo yokususa izicubu. Buza ukuthi isimangalo singena kusiphi isigaba, ukuthi ubufakazi baso bulinganise ukutholwa kwezilonda noma ukwelashwa, nokuthi yiluphi uhlobo lomkhiqizo nokugxila kwawo okuhloliwe ngempela. Izifundo ezisekela lokhu kuhlukaniswa zifakwe ohlwini emtatsheni wocwaningo lwe-methylene blue.