Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan.
Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
J Gastroenterol Hepatol. 2020 Feb;35(2):211-217. doi: 10.1111/jgh.14827. Epub 2019 Sep 1.
The study aims to clarify the endoscopic features and clinicopathological differences in superficial Barret's esophageal adenocarcinoma (s-BEA) derived from short-segment Barrett's esophagus (SSBE) and long-segment Barrett's esophagus (LSBE).
We reviewed data of 130 patients (141 lesions) with pathologically confirmed s-BEA (SSBE: 95 patients and 95 lesions; LSBE: 35 patients and 46 lesions). We analyzed endoscopic and clinicopathological features of s-BEA in patients with SSBE and LSBE.
The distribution of lesions according to macroscopic findings were as follows (s-BEA in SSBE vs LSBE): flat type (0-IIb), 3.2% (3/95) vs 32.6% (15/46) (P < 0.001); accompanied type 0-IIb, 2.1% (2/95) vs 21.7% (10/46) (P < 0.001); and complex type (0-I + IIb, 0-IIa + IIc, etc.), 30.5% (29/95) vs 50.0% (23/46) (P = 0.025). Complex-type s-BEAs had high incidences of T1b invasions and poorly differentiated components (simple type: 22.5% [20/89] and 18.0% [16/89]; complex type: 59.6% [31/52] and 44.2% [23/52], P < 0.001 and P = 0.002, respectively). In SSBE, 72.6% (69/95) of lesions were located at the right anterior wall (P = 0.01). All flat-type or depressed-type lesions derived from SSBE were identified as reddish areas, whereas only 65.2% (15/23) from LSBE were identified as reddish areas (P < 0.001).
In LSBE, flat-type, accompanied-type 0-IIb, and complex-type lesions were significantly more prevalent. Furthermore, complex-type s-BEAs tended to have T1b invasions and poorly differentiated components. S-BEAs in LSBE should be more carefully evaluated on endoscopic appearance including flat-type and complex-type lesions than in SSBE.
本研究旨在阐明短节段 Barrett 食管（SSBE）和长节段 Barrett 食管（LSBE）来源的浅表性 Barrett 食管腺癌（s-BEA）的内镜特征和临床病理差异。
我们回顾了经病理证实的 130 例 s-BEA 患者（141 处病变）的资料（SSBE：95 例和 95 处病变；LSBE：35 例和 46 处病变）。我们分析了 SSBE 和 LSBE 患者中 s-BEA 的内镜和临床病理特征。
根据大体观察结果，病变的分布如下（SSBE 中的 s-BEA 与 LSBE 相比）：平坦型（0-IIb），3.2%（3/95）与 32.6%（15/46）（P<0.001）；伴生型 0-IIb，2.1%（2/95）与 21.7%（10/46）（P<0.001）；和复杂型（0-I+IIb、0-IIa+IIc 等），30.5%（29/95）与 50.0%（23/46）（P=0.025）。复杂型 s-BEAs 具有较高的 T1b 浸润和低分化成分的发生率（单纯型：22.5%[20/89]和 18.0%[16/89]；复杂型：59.6%[31/52]和 44.2%[23/52]，P<0.001 和 P=0.002）。在 SSBE 中，72.6%（69/95）的病变位于食管右前壁（P=0.01）。所有平坦型或凹陷型病变均来源于 SSBE，均被认定为红色区域，而 LSBE 中仅有 65.2%（15/23）被认定为红色区域（P<0.001）。
LSBE 中，平坦型、伴生型 0-IIb 和复杂型病变更为常见。此外，复杂型 s-BEAs 倾向于具有 T1b 浸润和低分化成分。LSBE 中的 s-BEA 应比 SSBE 更仔细地评估其内镜表现，包括平坦型和复杂型病变。
