Gudlaugsdottir S, van Blankenstein M, Dees J, Wilson J H
Department of Internal Medicine, University Hospital Rotterdam, The Netherlands.
Eur J Gastroenterol Hepatol. 2001 Jun;13(6):639-45. doi: 10.1097/00042737-200106000-00005.
Endoscopic cancer surveillance has been advocated for patients with Barrett's oesophagus. However, only a small minority of patients dies from adenocarcinoma in Barrett's oesophagus. It has been calculated that endoscopic cancer surveillance will only add to the quality of life of individuals in whom the incidence of adenocarcinoma in Barrett's oesophagus is greater than 1/200 patient-years.
To determine the proportion of a consecutive cohort of patients, in whom Barrett's oesophagus was diagnosed over a 5-year period, likely to benefit from endoscopic cancer surveillance.
All patients who had died during the observation period or were over 75 years old and those with diseases likely to impair survival were excluded. Next, all patients in whom the risk of developing adenocarcinoma in Barrett's oesophagus fell below 1/200 patient-years were excluded (including all women, all men under the age of 60 and all men with Barrett's oesophagus of < 3 cm in length). Patients with dysplasia of any degree and/or presence of an ulcer or stricture in Barrett's oesophagus were reinstated.
Of 335 adult patients diagnosed with Barrett's oesophagus but without adenocarcinoma or high-grade dysplasia, 75 had died from unrelated causes, 47 had other diseases limiting survival and 59 were over 75 years old. After exclusion of all women, all men with Barrett's oesophagus of < 3 cm in length and all men under 60 years old, 15 patients were left. However, 32 were reinstated because of risk factors and another five because of insufficient data, resulting in 52 of the original 335 patients (15.5%) being eligible for endoscopic cancer surveillance.
This study suggests that less than 20% of patients identified with Barrett's oesophagus at routine endoscopy would benefit from endoscopic cancer surveillance. Prospective surveillance programmes should be limited to patients with an increased cancer risk and a good health profile.
对于巴雷特食管患者，一直提倡进行内镜癌症监测。然而，只有极少数巴雷特食管患者死于腺癌。据计算，内镜癌症监测只会增加巴雷特食管腺癌发病率大于1/200患者年的个体的生活质量。
确定在5年期间连续诊断为巴雷特食管的患者队列中，可能从内镜癌症监测中获益的比例。
排除观察期内死亡的所有患者、75岁以上患者以及患有可能影响生存的疾病的患者。接下来，排除所有巴雷特食管发生腺癌风险低于1/200患者年的患者（包括所有女性、所有60岁以下男性以及所有巴雷特食管长度小于3 cm的男性）。任何程度发育异常和/或巴雷特食管存在溃疡或狭窄的患者恢复纳入。
在335例诊断为巴雷特食管但无腺癌或高级别发育异常的成年患者中，75例死于无关原因，47例患有其他限制生存的疾病，59例年龄超过75岁。排除所有女性、所有巴雷特食管长度小于3 cm的男性以及所有60岁以下男性后，剩下15例患者。然而，32例因危险因素恢复纳入，另外5例因数据不足恢复纳入，导致335例原始患者中有52例（占15.5%）符合内镜癌症监测条件。
本研究表明，在常规内镜检查中确诊为巴雷特食管的患者中，不到20%的患者将从内镜癌症监测中获益。前瞻性监测计划应限于癌症风险增加且健康状况良好的患者。
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