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由训练有素的内镜医生进行专门的 Barrett 监测可提高异型增生的检出率。

Dedicated Barrett's surveillance sessions managed by trained endoscopists improve dysplasia detection rate.

机构信息

Department of Gastroenterology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom.

Department of Gastroenterology, Lewisham University Hospital, London, United Kingdom.

出版信息

Endoscopy. 2017 Jun;49(6):524-528. doi: 10.1055/s-0043-103410. Epub 2017 Apr 11.

Abstract

Barrett's esophagus (BE)-associated dysplasia is an important marker for risk of progression to esophageal adenocarcinoma (EAC) and an indication for endoscopic therapy. However, BE surveillance technique is variable. The aim of this study was to assess the effect of dedicated BE surveillance lists on dysplasia detection rate (DDR).  This was a prospective study of patients undergoing BE surveillance at two hospitals - community (UHL) and upper gastrointestinal center (GSTT). Four endoscopists (Group A) were trained in Prague classification, Seattle protocol biopsy technique, and lesion detection prior to performing BE surveillance endoscopies at both sites, with dedicated time slots or lists. The DDR was then compared with historical data from 47 different endoscopists at GSTT and 24 at UHL (Group B) who had undertaken Barrett's surveillance over the preceding 5-year period.  A total of 729 patients with BE underwent surveillance endoscopy between 2007 and 2012. There was no significant difference in patient age, sex, or length of BE between the two groups. There was a significant difference in detection rate of confirmed indefinite or low grade dysplasia and high grade dysplasia (HGD)/EAC between the two groups: 18 % (26 /142) Group A vs. 8 % (45/587) in Group B (  < 0.001). Documentation of Prague criteria and adherence to the Seattle protocol was significantly higher in Group A.  This study demonstrated that a group of trained endoscopists undertaking Barrett's surveillance on dedicated lists had significantly higher DDR than a nonspecialist cohort. These findings support the introduction of dedicated Barrett's surveillance lists.

摘要

巴雷特食管(BE)相关异型增生是食管腺癌(EAC)进展的重要标志物,也是内镜治疗的指征。然而,BE 监测技术存在差异。本研究旨在评估专门的 BE 监测清单对异型增生检出率(DDR)的影响。

这是一项在两家医院(社区医院[UHL]和上消化道中心[GSTT])进行 BE 监测的前瞻性研究。在这两个地点进行 BE 监测内镜检查之前,四名内镜医生(A 组)接受了布拉格分类、西雅图协议活检技术和病变检测方面的培训,并分配了专门的时间或清单。然后将 DDR 与 GSTT 47 名不同内镜医生和 UHL 24 名内镜医生(B 组)在过去 5 年进行的 Barrett 监测的历史数据进行比较。

2007 年至 2012 年间,共有 729 例 BE 患者接受了监测性内镜检查。两组患者的年龄、性别或 BE 长度无显著差异。两组之间确认的不确定或低级别异型增生和高级别异型增生(HGD)/EAC 的检出率存在显著差异:A 组为 18%(26/142),B 组为 8%(45/587)( < 0.001)。A 组中布拉格标准的记录和对西雅图协议的遵守情况明显更高。

本研究表明,一组专门从事 Barrett 监测的训练有素的内镜医生的 DDR 明显高于非专业医生组。这些发现支持引入专门的 Barrett 监测清单。

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