Pouw Roos E, Gondrie Joep J, Rygiel Agnieszka M, Sondermeijer Carine M, ten Kate Fiebo J, Odze Robert D, Vieth Michael, Krishnadath Kausilia K, Bergman Jacques J
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
Am J Gastroenterol. 2009 Jun;104(6):1366-73. doi: 10.1038/ajg.2009.88. Epub 2009 Apr 21.
Endoscopic radiofrequency ablation (RFA) eradicates intestinal metaplasia and intraepithelial neoplasia associated with Barrett's esophagus (BE), restoring an endoscopically normal neosquamous epithelium (NSE). We evaluated the post-RFA NSE for genetic abnormalities and buried glandular mucosa.
Eligible patients underwent RFA for BE containing early cancer and/or high-grade intraepithelial neoplasia with subsequent complete histological reversion to normal NSE. At baseline, the BE was sampled by brush cytology and biopsies. At least 2 months after RFA, the NSE was sampled by brush cytology, keyhole biopsies, and endoscopic resection. The untreated squamous epithelium was biopsied as a control. The baseline BE and post-RFA NSE were evaluated for immunohistochemical expression of Ki-67 and p53, and genetic abnormalities (DNA-fluorescent in situ hybridization: chromosome 1 and 9, p16 and p53). In addition, biopsy depth was compared for biopsies from the NSE and untreated squamous epithelium. The presence of buried glandular mucosa in NSE was assessed with primary and keyhole biopsy, and endoscopic resection.
All pretreatment specimens from all 22 patients showed abnormalities on immunohistochemical staining and fluorescent in situ hybridization, whereas all post-RFA NSE specimens were normal. All the post-RFA biopsies from the NSE contained full epithelia, whereas 37% contained lamina propria, a finding no different from biopsies from untreated squamous epithelium (36% lamina propria). Deeper keyhole biopsies contained lamina propria in 51%. All endoscopic resection specimens contained submucosa, whereas no biopsy or endoscopic resection specimen contained buried glandular mucosa.
Rigorous evaluation of the post-RFA NSE in patients who, at baseline, had BE containing early cancer high-grade intraepithelial neoplasia, showed neither persistent genetic abnormalities nor buried glandular mucosa.
内镜下射频消融术（RFA）可根除与巴雷特食管（BE）相关的肠化生和上皮内瘤变，恢复内镜下正常的新鳞状上皮（NSE）。我们评估了RFA术后NSE的基因异常情况和埋藏腺黏膜情况。
符合条件的患者接受了RFA治疗，其BE包含早期癌症和/或高级别上皮内瘤变，随后组织学完全恢复为正常NSE。在基线时，通过刷检细胞学和活检对BE进行采样。RFA至少2个月后，通过刷检细胞学、锁孔活检和内镜切除术对NSE进行采样。将未治疗的鳞状上皮进行活检作为对照。对基线BE和RFA术后NSE进行Ki-67和p53免疫组化表达以及基因异常（DNA荧光原位杂交：1号和9号染色体、p16和p53）评估。此外，比较NSE活检和未治疗鳞状上皮活检的活检深度。通过初次活检、锁孔活检和内镜切除术评估NSE中埋藏腺黏膜的存在情况。
所有22例患者的所有预处理标本在免疫组化染色和荧光原位杂交上均显示异常，而所有RFA术后NSE标本均正常。所有来自NSE的RFA术后活检均包含完整上皮，而37%包含固有层，这一发现与未治疗鳞状上皮活检无差异（36%包含固有层）。更深的锁孔活检中有51%包含固有层。所有内镜切除标本均包含黏膜下层，而没有活检或内镜切除标本包含埋藏腺黏膜。
对基线时患有包含早期癌症和高级别上皮内瘤变的BE患者的RFA术后NSE进行严格评估，结果显示既无持续性基因异常，也无埋藏腺黏膜。
