Departments of Gastroenterology and Hepatology, Center of Excellence for Barrett's Esophagus.
Anatomic Pathology.
J Clin Gastroenterol. 2020 Feb;54(2):144-149. doi: 10.1097/MCG.0000000000001165.
Visible lesions (VLs) in Barrett's esophagus (BE) are seen in 70% to 90% of patients presenting for endoscopic eradication therapy (EET). It is not known if there are any differences in outcomes of patients with flat dysplasia versus patients with VL. Our aim was to assess outcomes of EET in BE patients with VL and BE patients with flat dysplasia.
This is a single center study with data drawn from a prospective registry of patients referred for EET of BE between 2011 and 2015. Demographic data, endoscopic findings, histologic findings, and response to EET were analyzed.
There were 264 patients of which 34 had flat dysplasia, 180 had VL before initiating EET (prevalent lesions) and 50 who developed VL during EET (incident lesions). Compared with patients with flat dysplasia, patients with VL had longer segments of BE (5 vs. 4 cm, P=0.002) and greater prevalence of high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) (63.6% vs. 29.4%, P<0.001). Incident lesions are less likely to harbor HGD/EAC compared with prevalent lesions (28.1% vs. 61.8%, P<0.001). There were no significant differences in eradication of metaplasia/dysplasia between the groups. No progression or recurrences were observed in flat dysplasia group. In VL group, 14 patients progressed (prevalent VL=11, incident VL=3) and 15 had recurrences (prevalent VL=11, incident VL=4).
About 19% of BE patients developed VL during EET. There is higher prevalence of HGD/EAC in prevalent VL compared with incident VL. However, the outcomes did not differ.
在接受内镜下消除治疗（EET）的 Barrett 食管（BE）患者中，可见病变（VL）的发生率为 70%至 90%。目前尚不清楚 VL 与扁平上皮内瘤变患者的治疗结果是否存在差异。我们的目的是评估 BE 患者 VL 与 BE 患者扁平上皮内瘤变的 EET 治疗结果。
这是一项单中心研究，数据来自 2011 年至 2015 年期间因 BE 接受 EET 治疗的患者前瞻性登记。分析了人口统计学数据、内镜表现、组织学发现和 EET 反应。
共有 264 例患者，其中 34 例有扁平上皮内瘤变，180 例在开始 EET 前有 VL（前期病变），50 例在 EET 期间出现 VL（后期病变）。与扁平上皮内瘤变患者相比，VL 患者的 BE 段更长（5 厘米与 4 厘米，P=0.002），高级别上皮内瘤变（HGD）或食管腺癌（EAC）的患病率更高（63.6%与 29.4%，P<0.001）。与前期病变相比，后期病变中更不可能存在 HGD/EAC（28.1%与 61.8%，P<0.001）。两组在化生/上皮内瘤变的消除方面无显著差异。扁平上皮内瘤变组无进展或复发。VL 组中，14 例患者进展（前期 VL=11 例，后期 VL=3 例），15 例患者复发（前期 VL=11 例，后期 VL=4 例）。
约 19%的 BE 患者在 EET 期间出现 VL。与后期 VL 相比，前期 VL 中 HGD/EAC 的患病率更高。然而，治疗结果并无差异。
