Falk G W, Ours T M, Richter J E
Center for Swallowing and Esophageal Disorders, Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Gastrointest Endosc. 2000 Aug;52(2):197-203. doi: 10.1067/mge.2000.107728.
Endoscopic surveillance of Barrett's esophagus is recommended to detect dysplasia or cancer at an early and potentially treatable stage. However, little is known about the clinical practice patterns for endoscopic surveillance in the United States.
A questionnaire regarding surveillance intervals, techniques and management approaches for patients with Barrett's esophagus was mailed to 1000 randomly selected members of the Clinical Practice Section of the American Gastroenterological Association.
The response rate was 455 of 1000 (45%). Not all respondents answered all questions. Seventy-nine percent of respondents were in community practices, and 21% were in academic practices. Nearly all (96%) performed endoscopic surveillance, but it was practiced more commonly in the community (334 of 341 [98%]) than in the academic setting (83 of 93 [89%], p < 0.001). For patients without dysplasia, endoscopic surveillance was most commonly performed every 2 years (264 of 415 [64%]). Patients with low-grade dysplasia usually had surveillance endoscopy at 6-month intervals (215 of 413 [52%]), whereas those with high-grade dysplasia most commonly had endoscopy every 3 months (201 of 404 [50%]). These surveillance patterns did not differ between the academic and community groups. Random biopsies were performed by 93 of 403 (23%), 4-quadrant biopsies by 310 (77%). Most physicians (83%) used standard capacity forceps. Brush cytology was done uncommonly (69 of 414 [17%]). The most common indications for esophagectomy were high-grade dysplasia by 82% and cancer by 83%. Ablation therapy was performed for Barrett's esophagus without dysplasia by 3.5%, Barrett's with dysplasia by 20%, and cancer by 8%.
Surveillance for Barrett's esophagus is widely practiced in the United States but there is considerable variation in interval and technique. A clearer consensus on endoscopic surveillance is warranted to optimize care of patients with Barrett's esophagus.
推荐对巴雷特食管进行内镜监测，以便在早期且可能可治疗阶段检测发育异常或癌症。然而，关于美国内镜监测的临床实践模式知之甚少。
一份关于巴雷特食管患者监测间隔、技术和管理方法的问卷被邮寄给美国胃肠病学会临床实践分会随机挑选的1000名成员。
1000名中有455名回复（45%）。并非所有受访者都回答了所有问题。79%的受访者从事社区医疗，21%从事学术医疗。几乎所有（96%）都进行内镜监测，但在社区（341名中的334名[98%]）比在学术环境（93名中的83名[89%]）中更常见（p<0.001）。对于无发育异常的患者，内镜监测最常每2年进行一次（415名中的264名[64%]）。低级别发育异常患者通常每6个月进行一次监测性内镜检查（413名中的215名[52%]），而高级别发育异常患者最常每3个月进行一次内镜检查（404名中的201名[50%]）。这些监测模式在学术和社区组之间没有差异。403名中有93名（23%）进行随机活检，310名（77%）进行四象限活检。大多数医生（83%）使用标准容量钳。刷检细胞学检查不常用（414名中的69名[17%]）。食管切除术最常见的指征是高级别发育异常（82%）和癌症（83%）。对无发育异常的巴雷特食管进行消融治疗的比例为3.5%，有发育异常的为20%，癌症为8%。
在美国，巴雷特食管监测广泛开展，但在间隔和技术方面存在相当大的差异。有必要就内镜监测达成更明确的共识，以优化巴雷特食管患者的护理。
