Nottingham Digestive Diseases Centre and NIHR Biomedical Research Unit, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
World J Gastroenterol. 2010 Oct 7;16(37):4640-5. doi: 10.3748/wjg.v16.i37.4640.
Barrett's esophagus is a consequence of long standing gastro-esophageal reflux disease and predisposes to the development of esophageal adenocarcinoma. Regular surveillance endoscopies can detect curable early neoplasia in asymptomatic patients, which in turn could improve the prognosis compared to symptomatic cancer. Early neoplastic lesions, which are amenable for local therapy, could be treated endoscopically, avoiding a major surgery. However, in the absence of obvious mucosal lesions, random four quadrant biopsies are done, which is associated with significant sampling error. Newer imaging modalities, such as autofluorescence endoscopy, are helpful in detecting subtle lesions that could be examined in detail with narrow band imaging to characterize and target biopsies. This has the potential benefit of reducing the number of random biopsies with a better yield of dysplasia. Confocal endomicroscopy provides "optical biopsies" and is a valuable tool in targeting biopsies to improve dysplasia detection; however, this is technically challenging. Fuji intelligent chromoendoscopy and I-Scan are recent additions to the imaging armamentarium that have produced notable early results. While all these additional new imaging techniques are promising, a thorough examination by high resolution white light endoscopy after clearing the mucosa with mucolytics should be the minimum standard to improve dysplasia detection during Barrett's surveillance.
巴雷特食管是长期胃食管反流病的后果，易发展为食管腺癌。定期进行内镜监测可以在无症状患者中发现可治愈的早期肿瘤，从而改善预后，而不是等到出现症状后才发现癌症。对于早期肿瘤病变，可通过内镜进行局部治疗，从而避免大手术。然而，在没有明显黏膜病变的情况下，随机进行四个象限的活检，这与显著的采样误差相关。新型成像方式，如自发荧光内镜，有助于发现细微病变，随后使用窄带成像技术对其进行详细检查，以进行特征描述和靶向活检。这有可能通过减少随机活检的数量，并提高异型增生的检出率，从而带来获益。共聚焦内镜提供“光学活检”，是靶向活检以提高异型增生检测的有价值工具；然而，这在技术上具有挑战性。富士智能染色内镜和 I-Scan 是成像工具的新成员，已经取得了显著的早期成果。虽然所有这些额外的新成像技术都很有前景，但在使用黏液溶解剂清除黏膜后，应通过高分辨率白光内镜进行彻底检查，这是提高巴雷特食管监测中异型增生检出率的最低标准。
