Ogiya K, Kawano T, Ito E, Nakajima Y, Kawada K, Nishikage T, Nagai K
Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Dis Esophagus. 2008;21(7):645-9. doi: 10.1111/j.1442-2050.2008.00825.x. Epub 2008 May 2.
The designated area of the columnar-lined esophagus (CLE) is anatomically defined by the distal limit of the lower esophageal palisade vessels (LEPV) and the term 'Barrett's esophagus' is equally used along with the name CLE in Japan. The aim of this study was to investigate the actual prevalence of CLE based on the Japanese criteria and to evaluate the criteria per se. A total of 42 esophagi consecutively resected at this institute were included. All subjects underwent a surgical resection for squamous cell carcinoma of the esophagus. The position of the LEPV, squamocolumnar junction, the prevalence of CLE and intestinal metaplasia were investigated both pre- and postoperatively. Preoperative endoscopy revealed CLE based on the Japanese criteria in half of all patients. In the resected specimens the distal limit of LEPV was lower than the squamocolumnar junction in 95.2%. In other words, almost all cases had CLE (equivalent to Barrett's mucosa in Japanese criteria). However, most of the CLE areas were very short and their average maximum length was only about 5 mm. In addition, no intestinal metaplasia was observed in any of the CLE cases. Almost all individuals might therefore be diagnosed to have CLE or Barrett's mucosa based on precise endoscopic observations in Japan. The CLE located in a small area, e.g. less than 5 mm, defined according to the LEPV criteria without any other factor concerning typical Barrett's esophagus such as signs of gastroesophageal reflux should therefore be excluded from consideration as a high-risk mucosa.
柱状上皮化生食管（CLE）的指定区域在解剖学上由食管下段栅栏状血管（LEPV）的远端界限界定，在日本，“巴雷特食管”这一术语与CLE名称通用。本研究的目的是根据日本标准调查CLE的实际患病率，并对该标准本身进行评估。本研究纳入了本机构连续切除的42例食管。所有受试者均因食管鳞状细胞癌接受手术切除。术前和术后均对LEPV的位置、鳞柱状交界、CLE的患病率以及肠化生情况进行了调查。术前内镜检查显示，所有患者中有一半符合日本标准的CLE。在切除标本中，95.2%的患者LEPV的远端界限低于鳞柱状交界。换句话说，几乎所有病例都有CLE（根据日本标准相当于巴雷特黏膜）。然而，大多数CLE区域非常短，其平均最大长度仅约5毫米。此外，在任何CLE病例中均未观察到肠化生。因此，在日本，几乎所有个体根据精确的内镜观察可能被诊断为患有CLE或巴雷特黏膜。因此，根据LEPV标准定义的位于小区域（例如小于5毫米）的CLE，若不存在任何其他与典型巴雷特食管相关的因素（如胃食管反流迹象），不应被视为高危黏膜。
