Division of Gastroenterology and Hepatology, University of Colorado and Veterans Affairs Medical Center, Denver, CO, USA.
Dig Dis Sci. 2013 Jun;58(6):1703-9. doi: 10.1007/s10620-013-2689-7. Epub 2013 Apr 30.
There are limited data on the effect of endoscopic mucosal resection (EMR) on changes of histopathologic diagnosis for Barrett's esophagus (BE) patients undergoing endoscopic eradication therapy (EET); especially those without visible lesions.
To compare the frequency of changes of diagnosis by EMR compared with pre-EMR biopsy diagnosis for patients with and without visible lesions.
In this multicenter outcomes project, patients with Barrett's-related neoplasia undergoing EET at three tertiary-care centers were included. Patients undergoing biopsies followed by EMR within six months were included. The main outcome measures were frequency of overall change of histopathologic diagnosis, change based on pre-EMR biopsy diagnosis, and change based on the presence of visible lesions.
One-hundred and thirty-eight BE patients (low-grade dysplasia (LGD) 15 (10.9 %), high-grade dysplasia (HGD) 87 (63 %), esophageal adenocarcinoma (EAC) 36 (26.1 %)) were included; 114 (82.6 %) patients had visible lesions. EMR resulted in a change of diagnosis for 43 (31.1 %) patients (upgrade 14 (10.1 %); downgrade 29 (21 %)). For HGD patients, EMR downstaged dysplasia grade for 17 (19.5 %) cases and upstaged it to EAC for nine (10.3 %) cases. There was a change of diagnosis for 26 (29.9 %) HGD patients, irrespective of the presence or absence of visible lesions (p = 0.76). For EAC patients, EMR downstaged dysplasia grade in 10 (27.8 %) cases. There was a change of diagnosis for 10 (27.8 %) EAC patients, irrespective of the presence or absence of endoscopically visible lesions (p = 0.48).
EMR results in a change of diagnosis for approximately 30 % of BE patients with early neoplasia (with and without visible lesions) referred for EET.
对于接受内镜下根除治疗（EET）的 Barrett 食管（BE）患者，内镜黏膜切除术（EMR）对组织病理学诊断变化的影响的数据有限；特别是对于那些没有可见病变的患者。
比较有和无可见病变的患者，EMR 与 EMR 前活检诊断相比，诊断变化的频率。
在这项多中心结局研究中，纳入了在三家三级护理中心接受 EET 的伴有 BE 相关肿瘤的患者。在 6 个月内接受 EMR 联合活检的患者被纳入研究。主要观察指标为组织病理学诊断的总体变化频率、基于 EMR 前活检诊断的变化和基于可见病变的变化。
共纳入 138 例 BE 患者（低级别上皮内瘤变（LGD）15 例（10.9%），高级别上皮内瘤变（HGD）87 例（63%），食管腺癌（EAC）36 例（26.1%））；114 例（82.6%）患者有可见病变。EMR 导致 43 例（31.1%）患者的诊断发生变化（升级 14 例（10.1%）；降级 29 例（21%））。对于 HGD 患者，EMR 降级了 17 例（19.5%）病例的异型增生程度，并将 9 例（10.3%）病例升级为 EAC。26 例（29.9%）HGD 患者无论是否有可见病变均发生了诊断变化（p = 0.76）。对于 EAC 患者，EMR 降级了 10 例（27.8%）病例的异型增生程度。10 例（27.8%）EAC 患者无论是否有内镜下可见病变，诊断均发生了变化（p = 0.48）。
对于接受 EET 的伴有早期肿瘤（有和无可见病变）的 BE 患者，EMR 导致约 30%的患者诊断发生变化。
