射频消融治疗异型增生的 Barrett 食管后的活检深度。
Biopsy depth after radiofrequency ablation of dysplastic Barrett's esophagus.
机构信息
Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7080, USA.
出版信息
Gastrointest Endosc. 2010 Sep;72(3):490-496.e1. doi: 10.1016/j.gie.2010.04.010. Epub 2010 Jul 3.
BACKGROUND
After endoscopic radiofrequency ablation (RFA) of dysplastic Barrett's esophagus (BE), endoscopic biopsy samples are obtained to assess response to therapy. Whether these biopsies are of adequate depth to assess efficacy is unknown.
OBJECTIVE
To compare the depth of endoscopic biopsy samples after RFA with those of untreated controls and to determine the prevalence of subepithelial structures in endoscopic biopsy fragments.
DESIGN
Secondary analysis of the AIM Dysplasia Trial, a multicenter, randomized, sham-controlled study.
SETTING
Nineteen treatment centers.
PATIENTS
Subjects with dysplastic BE, either status post RFA or ablation naïve (sham).
MAIN OUTCOME MEASUREMENTS
The proportion of biopsy samples demonstrating subepithelial structures, stratified by tissue type (columnar vs squamous) in sham- and RFA-treated subjects.
RESULTS
A total of 5648 biopsy fragments were analyzed from 113 subjects (78 RFA, 35 sham; mean 50.0 fragments per subject). Most fragments (4653, 82.4%) contained subepithelium. Squamous biopsy samples from RFA and sham subjects demonstrated subepithelium at similar rates (78.4% vs 79.1%, respectively, P = not significant [NS]). Columnar biopsy samples from RFA and sham subjects also included subepithelium at similar rates (99.0% vs 98.8%, respectively, P = NS). Regardless of treatment assignment, more columnar than squamous biopsy samples demonstrated subepithelium (98.8% vs 78.5%, P < .001).
LIMITATIONS
Biopsy samples were not individually mounted.
CONCLUSIONS
In both squamous and columnar tissue, endoscopic biopsy samples after RFA were as likely to demonstrate subepithelium as untreated controls. Almost 80% of all biopsy samples were adequate to evaluate for subsquamous intestinal metaplasia. The primary determinant of biopsy depth is the type of epithelium that underwent biopsy, with squamous less likely to yield subepithelium than columnar. Biopsy samples after RFA appear to be of adequate depth to assess response to therapy. (Clinical trial registration number NCT00282672.).
背景
内镜下射频消融（RFA）治疗异型增生性 Barrett 食管（BE）后，需获取内镜活检样本以评估治疗反应。但目前尚不清楚这些活检样本的深度是否足以评估疗效。
目的
比较 RFA 后内镜活检样本的深度与未经治疗对照的活检样本深度，并确定上皮下结构在内镜活检组织块中的检出率。
设计
多中心、随机、假对照的 AIM 异型增生试验的二次分析。
设置
19 个治疗中心。
患者
有异型增生性 BE 的患者，包括 RFA 后或消融前（假对照）。
主要观察指标
在 RFA 治疗和假对照治疗的患者中，按组织类型（柱状 vs 鳞状）分层，评估活检样本中上皮下结构的检出率。
结果
共分析了 113 例患者（78 例 RFA，35 例假对照）的 5648 个活检组织块（平均每个患者 50.0 个活检组织块）。大多数活检组织块（4653 个，82.4%）均存在上皮下组织。RFA 和假对照治疗的患者中，鳞状活检组织块中检出上皮下组织的比例相似（分别为 78.4%和 79.1%，P=非显著性[NS]）。RFA 和假对照治疗的患者中，柱状活检组织块中检出上皮下组织的比例也相似（分别为 99.0%和 98.8%，P=NS）。无论治疗分组如何，柱状活检组织块中检出上皮下组织的比例均显著高于鳞状活检组织块（分别为 98.8%和 78.5%，P<0.001）。
局限性
活检组织块未单独进行装裱。
结论
在鳞状和柱状组织中，RFA 后的内镜活检样本与未经治疗的对照相比，更有可能显示上皮下组织。几乎 80%的所有活检样本均足以评估黏膜下固有层内的肠化生。活检深度的主要决定因素是接受活检的上皮类型，柱状上皮活检组织块中检出上皮下组织的可能性显著低于鳞状上皮活检组织块。RFA 后的活检样本深度似乎足以评估治疗反应。（临床试验注册号：NCT00282672）。
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