Department of Upper Gastrointestinal Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Department of Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Surg Endosc. 2021 Aug;35(8):4756-4762. doi: 10.1007/s00464-020-07950-5. Epub 2020 Sep 2.
INTRODUCTION: The identification and follow-up of ultra-short Barrett's esophagus (BE) is controversial. BE surveillance guidelines emphasize mainly on long-segment BE. However, in practice a substantial proportion of esophageal adenocarcinoma (EAC) are found close to the gastro-esophageal junction (GEJ). Our study aims to chart the length of BE when low-grade dysplasia (LGD), high-grade dysplasia (HGD) and EAC arise in BE. METHODS: Endoscopic findings from all cases with a diagnosis of LGD and HGD in BE between June 2014 and June 2019, and 100 consecutive cases of EAC diagnosed between June 2018 and August 2019, were reviewed. Additionally, 438 consecutive gastroscopies were reviewed to identify 100 cases of non-dysplastic BE. RESULTS: 99 cases of LGD and 61 cases of HGD were reviewed. LGD and HGD when diagnosed, was located in BE ≤ 1 cm in 20% and 18% cases, respectively. LGD and HGD when diagnosed, was located in BE ≤ 3 cm in 48.5% and 40.9% cases, respectively. LGD and HGD when diagnosed in BE ≤ 3 cm was found at index endoscopy in 67% and 42% cases, respectively. Of the 100 cases of EAC, only 23 had concurrent visible BE, with BE higher than the level of EAC in seven. EAC when found, had its proximal extent ≤ 1 cm from GEJ in 22% and ≤ 3 cm from GEJ in 40% cases. Of the 100 non-dysplastic BE, 53% were ≤ 1 cm and 78% were ≤ 3 cm long. CONCLUSION: Almost 20% of all dysplasia in BE occurs in BE < 1 cm. Over 40% occurs in BE < 3 cm. Similarly, 20% of EAC occurs within 1 cm of GEJ and 40% occur within 3 cm. A majority of dysplasia diagnosed within 3 cm of the GEJ is found on index endoscopy. We propose that all lengths of columnar lined epithelium above the GEJ are recognized as BE and subjected to a thorough biopsy protocol.
简介:超短 Barrett 食管(BE)的识别和随访存在争议。BE 监测指南主要强调长节段 BE。然而,在实践中,相当一部分食管腺癌(EAC)位于胃食管交界处(GEJ)附近。我们的研究旨在绘制当 BE 出现低级别异型增生(LGD)、高级别异型增生(HGD)和 EAC 时的 BE 长度。
方法:回顾 2014 年 6 月至 2019 年 6 月期间所有诊断为 LGD 和 HGD 的 BE 病例内镜检查结果,以及 2018 年 6 月至 2019 年 8 月期间诊断的 100 例连续 EAC 病例。此外,还回顾了 438 例连续胃镜检查,以确定 100 例非异型增生 BE。
结果:共回顾了 99 例 LGD 和 61 例 HGD。LGD 和 HGD 诊断时,分别有 20%和 18%位于 BE≤1cm。LGD 和 HGD 诊断时,分别有 48.5%和 40.9%位于 BE≤3cm。LGD 和 HGD 诊断时位于 BE≤3cm 的病例,在索引内镜检查时分别有 67%和 42%发现。在 100 例 EAC 中,仅 23 例有可见的 BE,其中 7 例 BE 高于 EAC。EAC 发现时,其近端距 GEJ 小于或等于 1cm 的比例为 22%,距 GEJ 小于或等于 3cm 的比例为 40%。在 100 例非异型增生 BE 中,53%的长度小于或等于 1cm,78%的长度小于或等于 3cm。
结论:几乎 20%的 BE 所有异型增生发生在 BE<1cm。超过 40%发生在 BE<3cm。同样,20%的 EAC 发生在 GEJ 1cm 以内,40%发生在 GEJ 3cm 以内。GEJ 附近 3cm 内诊断出的大多数异型增生在索引内镜检查中发现。我们建议将 GEJ 以上所有柱状上皮的长度都视为 BE,并进行彻底的活检。
Dis Esophagus. 2017-3-1
Clin Gastroenterol Hepatol. 2014-8-4
Clin Gastroenterol Hepatol. 2013-5-22
Clin Gastroenterol Hepatol. 2015-12-31
Cancer Epidemiol Biomarkers Prev. 2017-2
Am J Gastroenterol. 1997-11
World J Gastroenterol. 2016-10-21
Am J Gastroenterol. 2025-3-7
Dig Dis Sci. 2024-8
Nat Rev Gastroenterol Hepatol. 2022-9
Acta Biomed. 2022-3-14