Martinek J, Benes M, Brandtl P, Hucl T, Vasicek M, Voska L, Lanska V, Nosek V, Spicak J
Department of Hepatogastroenterology, IKEM (Institute for Clinical and Experimental Medicine), Prague, Czech Republic.
Endoscopy. 2008 Sep;40(9):711-6. doi: 10.1055/s-2008-1077502. Epub 2008 Aug 12.
Barrett's esophagus is a premalignant condition. The risk of developing high grade intraepithelial neoplasia (HGIN) or adenocarcinoma is currently a matter of debate. Due to several shortcomings, previous studies have probably overestimated the risk. The main aim of our study was to investigate the incidence of HGD and adenocarcinoma in a cohort of patients with Barrett's esophagus.
In a prospective, cohort study, all patients had intestinal metaplasia and macroscopic evidence of short- or long-segment (< 3 cm or > or = 3 cm) Barrett's esophagus. All patients underwent a standard protocol including regular endoscopies with biopsies and were treated with a proton pump inhibitor or antireflux surgery.
A total of 135 patients underwent 623 endoscopies during 700 patient-years (mean follow-up 5.2 +/- 2.3 years). Simultaneous HGIN and adenocarcinoma were detected in two patients with long-segment Barrett's esophagus (1.5%; 2 and 6 years after the index endoscopy). Low grade intraepithelial neoplasia (LGIN) was detected in 25 patients (18.5%); in 11 of these patients (44%), LGIN was not confirmed in later biopsies. Our study shows an incidence of HGIN/adenocarcinoma of 1/350 patient-years. Endoscopic regression of Barrett's esophagus was seen in 20.7% of patients.
The incidence of HGIN/adenocarcinoma is low in patients with adequately treated Barrett's esophagus. The annual risk of developing HGIN/adenocarcinoma is 0.21% (1.6% in long-segment Barrett's esophagus).
巴雷特食管是一种癌前病变。目前，发生高级别上皮内瘤变（HGIN）或腺癌的风险存在争议。由于存在若干缺陷，既往研究可能高估了该风险。我们研究的主要目的是调查一组巴雷特食管患者中HGIN和腺癌的发生率。
在一项前瞻性队列研究中，所有患者均有肠化生及短段或长段（<3 cm或≥3 cm）巴雷特食管的宏观证据。所有患者均接受了包括定期内镜检查及活检的标准方案，并接受质子泵抑制剂或抗反流手术治疗。
在700患者年期间，共有135例患者接受了623次内镜检查（平均随访5.2±2.3年）。在2例长段巴雷特食管患者中同时检测到HGIN和腺癌（1.5%；在初次内镜检查后2年和6年）。25例患者检测到低级别上皮内瘤变（LGIN）（18.5%）；其中11例患者（44%）在后续活检中未证实LGIN。我们的研究显示HGIN/腺癌的发生率为1/350患者年。20.7%的患者可见巴雷特食管的内镜下消退。
经过充分治疗的巴雷特食管患者中HGIN/腺癌的发生率较低。发生HGIN/腺癌的年风险为0.21%（长段巴雷特食管患者中为1.6%）。
