Barrett 食管中高级别异型增生与黏膜内癌内镜下根除治疗后异型增生和癌复发的比较风险。
Comparative risk of recurrence of dysplasia and carcinoma after endoluminal eradication therapy of high-grade dysplasia versus intramucosal carcinoma in Barrett's esophagus.
机构信息
Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
出版信息
Gastrointest Endosc. 2015 May;81(5):1158-66.e1-4. doi: 10.1016/j.gie.2014.10.029. Epub 2015 Jan 31.
BACKGROUND
Endoscopic therapy is the preferred approach for the management of Barrett's esophagus (BE) patients with high-grade dysplasia (HGD) and intramucosal carcinoma (IMC). Little is known about outcome differences in patients with HGD versus IMC.
OBJECTIVE
To determine and compare the rate of recurrent dysplasia or neoplasia in patients with HGD or IMC undergoing endoscopic therapy.
DESIGN
Retrospective cohort study.
PATIENTS
A total of 246 BE patients with either HGD or IMC referred for endoscopic therapy.
INTERVENTION
Patients underwent EMR and/or ablation therapy with the goal of complete eradication of all dysplasia/neoplasia and intestinal metaplasia (CE-IM). Patients were assigned to either the HGD or IMC group based on highest pathology grade at the start of therapy.
MAIN OUTCOME MEASUREMENTS
Complete eradication and recurrence of IM and/or HGD/neoplasia were assessed among patients with HGD versus IMC. Only patients with CE-IM (documented eradication of all dysplasia/neoplasia and IM on a single endoscopy) were included for analysis of recurrence rates and risk factors.
RESULTS
CE-IM was achieved in 113 of 135 patients (83.7%) with HGD and in 84 of 111 patients (75.7%) with IMC (P = .16). Overall recurrence rates of dysplasia or neoplasia after CE-IM were similar in both groups (HGD, 8.0% vs IMC, 9.5%; P = .44; relative risk, 1.2; 95% confidence interval, 0.5-3.0) and remained similar in patients with 5 years of surveillance after CE-IM (HGD, 13.5% vs IMC, 11.4%; P = .53; relative risk, 0.85; 95% confidence interval, 0.3-2.7).
LIMITATIONS
Retrospective, observational study and evolution of endoscopic modalities and experience.
CONCLUSION
Endoluminal therapy can successfully achieve eradication of IM and dysplasia or neoplasia in BE patients with HGD and IMC at comparable rates. There were no differences in the rates of recurrent HGD/IMC in the 2 groups.
背景
内镜治疗是 Barrett 食管（BE）伴高级别异型增生（HGD）和黏膜内癌（IMC）患者的首选治疗方法。对于 HGD 与 IMC 患者的治疗结局差异，目前知之甚少。
目的
旨在确定和比较 HGD 与 IMC 患者行内镜治疗后，异型增生或肿瘤复发的发生率。
设计
回顾性队列研究。
患者
共有 246 例 BE 患者，HGD 或 IMC 患者均接受内镜治疗。
干预措施
患者行 EMR 和/或消融治疗，以完全消除所有异型增生/肿瘤和肠化生（CE-IM）为目标。根据治疗开始时的最高病理分级，患者被分为 HGD 或 IMC 组。
主要观察指标
在 HGD 与 IMC 患者中，评估 HGD 与 IMC 患者的完全消除率和 IM 及 HGD/肿瘤的复发率。仅纳入 CE-IM 患者（单内镜下记录所有异型增生/肿瘤和 IM 的完全消除）进行复发率和危险因素分析。
结果
135 例 HGD 患者中，113 例（83.7%）实现了 CE-IM，111 例 IMC 患者中，84 例（75.7%）实现了 CE-IM（P =.16）。CE-IM 后，两组异型增生或肿瘤的总体复发率相似（HGD，8.0% vs IMC，9.5%；P =.44；相对风险，1.2；95%置信区间，0.5-3.0），CE-IM 后 5 年监测时，两组的复发率也相似（HGD，13.5% vs IMC，11.4%；P =.53；相对风险，0.85；95%置信区间，0.3-2.7）。
局限性
回顾性、观察性研究以及内镜治疗方式和经验的演变。
结论
在内镜治疗中，HGD 和 IMC 的 BE 患者可成功实现 IM 和异型增生或肿瘤的根除，且两组的根除率相似。两组患者的 HGD/IMC 复发率无差异。
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