Melson J, Desai V, Greenspan M, Yau S, Abdalla M, Dhanekula R, Mobarhan S, Shapiro D, Losurdo J, Jakate S
Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA.
Dis Esophagus. 2015 Oct;28(7):660-5. doi: 10.1111/dote.12250. Epub 2014 Jun 18.
Surveillance endoscopy of non-dysplastic Barrett's esophagus (NDBE) that fails to detect intestinal metaplasia (IM), or negative surveillance, is known to occur in clinical practice, although the frequency and possible outcomes in a large cohort in clinical practice is not well described. The goals of this study were to define frequency in which negative surveillance occurs and endoscopic outcomes in a screening cohort of short segment NDBE. A retrospective cohort (n = 184) of patients newly diagnosed with short segment NDBE at an outpatient academic tertiary care center between 2003 and 2011 were reviewed. Only those with one or more surveillance endoscopies were included to define a frequency of negative surveillance. Included patients were further assessed if they had two or more surveillance endoscopies and were classified into groups as sampling error or negative IM on consecutive surveillances based on the results of their surveillance endoscopies. The frequency of a negative surveillance endoscopy in all short-segment NDBE patients was 19.66% (92 endoscopic exams were negative for IM of 468 total surveillance exams). A negative surveillance endoscopy occurred in 40.76% (n = 75) patients. Sampling error occurred in 44.12% and negative IM on consecutive surveillance endoscopies in 55.88% of those with ≥ 2 surveillance endoscopies and an initially negative surveillance exam. The frequency of negative IM on consecutive surveillances was 19.00% of all patients who had two surveillance endoscopies. When the index diagnostic Barrett's esophagus segment length was < 1 cm, 32.14% (18/56) of all patients (with ≥ 2 surveillance endoscopies) had negative IM on consecutive surveillance endoscopies. Negative surveillance occurs frequently in short-segment NDBE. When an initial negative surveillance endoscopy occurs, it may be due to either a sampling error or lack of detectable IM on surveillance exam. When a <1 cm segment of NDBE is diagnosed, a significant proportion of patients may go on to have continuously undetected IM on consecutive surveillance endoscopic exams without intervention.
在临床实践中，未检测到肠化生（IM）的非发育异常性巴雷特食管（NDBE）的监测性内镜检查，即阴性监测，时有发生，尽管临床实践中大型队列的发生频率和可能结果尚无详尽描述。本研究的目的是确定短节段NDBE筛查队列中阴性监测的发生频率和内镜检查结果。回顾性分析了2003年至2011年间在一家门诊学术三级医疗中心新诊断为短节段NDBE的患者队列（n = 184）。仅纳入那些接受过一次或多次监测性内镜检查的患者来确定阴性监测的频率。对纳入的患者进一步评估其是否接受过两次或更多次监测性内镜检查，并根据监测性内镜检查结果将其分为连续监测时存在抽样误差或阴性IM的组。所有短节段NDBE患者中阴性监测性内镜检查的频率为19.66%（468次总监测检查中92次内镜检查IM为阴性）。40.76%（n = 75）的患者出现了阴性监测性内镜检查。在接受≥2次监测性内镜检查且初始监测检查为阴性的患者中，44.12%出现抽样误差，55.88%在连续监测性内镜检查中出现阴性IM。在所有接受两次监测性内镜检查的患者中，连续监测时阴性IM的频率为19.00%。当索引诊断的巴雷特食管节段长度<1 cm时，所有患者（接受≥2次监测性内镜检查）中有32.14%（18/56）在连续监测性内镜检查中出现阴性IM。阴性监测在短节段NDBE中频繁发生。当出现初始阴性监测性内镜检查时，可能是由于抽样误差或监测检查时未检测到IM。当诊断出NDBE节段<1 cm时，相当一部分患者在连续监测性内镜检查中可能持续未检测到IM而无需干预。
