Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee 37232-5280, USA.
Gastrointest Endosc. 2013 Jun;77(6):877-82. doi: 10.1016/j.gie.2013.01.026. Epub 2013 Mar 23.
Accurate endoscopic detection and staging are critical for appropriate management of Barrett's esophagus (BE)-associated neoplasia. Prior investigation has demonstrated that the distribution of endoscopically detectable early neoplasia is not uniform but instead favors specific directional distributions within a short BE segment; however, it is unknown whether the directional distribution of neoplasia differs with increasing distance from the gastroesophageal junction, including in patients with long-segment BE.
To identify whether directional distribution of BE-associated neoplasia is influenced by distance from the gastroesophageal junction.
Retrospective cohort study.
Tertiary-care referral center.
Patients with either short-segment or long-segment BE undergoing EMR.
EMR.
Directional distribution of BE-associated neoplasia stratified by distance from gastroesophageal junction.
EMR was performed on 60 lesions meeting study criteria during the specified time period. Pathology demonstrated low-grade dysplasia in 22% (13/60), high-grade dysplasia in 38% (23/60), intramucosal (T1a) adenocarcinoma in 23% (14/60), and invasive (≥ T1b) adenocarcinoma in 17% (10/60). Directional distribution of lesions was not uniform (P < .001), with 62% of lesions (37/60) located between the 1 o'clock and 5 o'clock positions. When circular statistics methodology was used, there was no difference in the directional distribution of neoplastic lesions located within 3 cm of the gastroesophageal junction compared with ≥ 3 cm from the gastroesophageal junction.
Single-center study may limit external validity.
The directional distribution of neoplastic foci within a BE segment is not influenced by distance of the lesion from the gastroesophageal junction. Mucosa between the 1 o'clock and 5 o'clock locations merits careful attention and endoscopic inspection in individuals with both short-segment BE and long-segment BE.
准确的内镜检测和分期对于 Barrett 食管（BE）相关肿瘤的适当管理至关重要。先前的研究表明，内镜可检测到的早期肿瘤的分布并不均匀，而是在短段 BE 内偏向于特定的方向性分布；然而，尚不清楚肿瘤的方向性分布是否会随着距胃食管交界处（GEJ）的距离增加而不同，包括在长段 BE 患者中。
确定 BE 相关肿瘤的方向性分布是否受距 GEJ 距离的影响。
回顾性队列研究。
三级医疗中心。
接受 EMR 的短段或长段 BE 患者。
EMR。
根据距 GEJ 的距离分层的 BE 相关肿瘤的方向性分布。
在指定时间段内，60 个符合研究标准的病变进行了 EMR。病理显示低级别上皮内瘤变占 22%（13/60），高级别上皮内瘤变占 38%（23/60），黏膜内（T1a）腺癌占 23%（14/60），浸润性（≥T1b）腺癌占 17%（10/60）。病变的方向性分布不均匀（P<0.001），62%（37/60）的病变位于 1 点至 5 点位置之间。当使用圆形统计学方法时，距 GEJ 3cm 内和≥3cm 处的肿瘤病变的方向性分布无差异。
单中心研究可能会限制外部有效性。
BE 段内肿瘤灶的方向性分布不受病变距 GEJ 距离的影响。在短段 BE 和长段 BE 患者中，1 点至 5 点位置之间的黏膜值得密切关注和内镜检查。
