Center for Endoscopic Research and Therapeutics, Department of Medicine, University of Chicago Medicine, Chicago, Illinois.
Department of Pathology, University of Chicago Medicine, Chicago, Illinois.
Clin Gastroenterol Hepatol. 2014 Dec;12(12):2002-10.e1-2. doi: 10.1016/j.cgh.2014.04.010. Epub 2014 Apr 13.
BACKGROUND & AIMS: Barrett's esophagus (BE) with high-grade dysplasia (HGD) or intramucosal carcinoma (IMC) is treated by complete eradication of areas of BE by endoscopic mucosal resection (EMR). By using this approach, histologic analysis also can be performed. We investigated the effectiveness, safety, and durability of this approach, as well as its use in diagnosis after a single referral.
We collected data from 107 patients who were referred to the Center for Endoscopic Research and Therapeutics at the University of Chicago for BE (mean length, 3.6 cm) with suspected HGD or IMC, from August 2003 through December 2012. All patients underwent EMR and were followed up through January 2014 (mean follow-up time, 40.6 mo). The primary outcome was treatment efficacy (complete eradication of BE and associated neoplasia); secondary outcomes included safety, durability, and accuracy of diagnosis.
BE was eradicated completely by EMR in 80.4% (86 of 107) of patients based on intention-to-treat analysis, and in 98.8% (79 of 80) of patients based on per-protocol analysis. The diagnosis was changed for 25% of patients after EMR, including 4 cases that initially were diagnosed as HGD by biopsy analysis and subsequently were found to have evidence of submucosal invasion when EMR specimens were assessed. Strictures and symptomatic dysphagia developed in 41.1% and 37.3% of patients, respectively, with an average of 2.3 dilations required. Perforations occurred in 2 patients after EMR and in 1 patient after dilation. HGD and IMC recurred in 1 patient each; both were treated successfully with EMR. Based on pathology analysis of the most recently collected specimens, 71.6% of patients (53 of 74) were in complete remission from intestinal metaplasia and 100% were in complete remission from HGD (74 of 74) or cancer (74 of 74).
For patients with BE with HGD or neoplasia, complete EMR is an effective and durable treatment and is a relatively safe technique. Specimens collected by EMR also can be analyzed histologically to aid in diagnosis. The common complication of EMR is esophageal stricture, which can be addressed with endoscopic dilation.
巴雷特食管（BE）伴高级别异型增生（HGD）或黏膜内癌（IMC）通过内镜黏膜切除术（EMR）完全清除 BE 区域进行治疗。通过这种方法，也可以进行组织学分析。我们研究了这种方法的有效性、安全性和持久性，以及在单次转诊后的诊断中的应用。
我们收集了 2003 年 8 月至 2012 年 12 月期间，因疑似 HGD 或 IMC 而被转介到芝加哥大学内镜研究和治疗中心的 107 例 BE（平均长度为 3.6cm）患者的数据。所有患者均接受 EMR 治疗，并随访至 2014 年 1 月（平均随访时间为 40.6 个月）。主要结局是治疗效果（完全清除 BE 和相关肿瘤）；次要结局包括安全性、持久性和诊断准确性。
根据意向治疗分析，80.4%（107 例中有 86 例）的患者通过 EMR 完全清除了 BE，根据方案分析，98.8%（80 例中有 79 例）的患者完全清除了 BE。25%的患者在 EMR 后诊断发生改变，包括 4 例活检分析最初诊断为 HGD，随后在评估 EMR 标本时发现有黏膜下浸润证据。41.1%和 37.3%的患者分别出现狭窄和有症状的吞咽困难，平均需要 2.3 次扩张。2 例患者在 EMR 后发生穿孔，1 例患者在扩张后发生穿孔。1 例患者 HGD 复发，1 例患者 IMC 复发，均通过 EMR 成功治疗。根据最近收集标本的病理分析，71.6%（74 例中有 53 例）的患者肠上皮化生完全缓解，100%（74 例中有 74 例）的患者 HGD（74 例中有 74 例）或癌症完全缓解（74 例中有 74 例）。
对于 HGD 或肿瘤的 BE 患者，完全 EMR 是一种有效且持久的治疗方法，也是一种相对安全的技术。EMR 采集的标本也可以进行组织学分析以辅助诊断。EMR 的常见并发症是食管狭窄，可通过内镜扩张解决。
