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存在低级别异型增生、高级别异型增生和腺癌时的 Barrett 食管长度。

Length of Barrett's esophagus in the presence of low-grade dysplasia, high-grade dysplasia, and adenocarcinoma.

机构信息

Department of Upper Gastrointestinal Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.

Department of Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.

出版信息

Surg Endosc. 2021 Aug;35(8):4756-4762. doi: 10.1007/s00464-020-07950-5. Epub 2020 Sep 2.


DOI:10.1007/s00464-020-07950-5
PMID:32880012
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8263447/
Abstract

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.

摘要

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/14ab/8263447/8fa7a936acf9/464_2020_7950_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/14ab/8263447/c67e3555a4cb/464_2020_7950_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/14ab/8263447/6c706bf60c7a/464_2020_7950_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/14ab/8263447/3ad035599e12/464_2020_7950_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/14ab/8263447/8fa7a936acf9/464_2020_7950_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/14ab/8263447/c67e3555a4cb/464_2020_7950_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/14ab/8263447/6c706bf60c7a/464_2020_7950_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/14ab/8263447/3ad035599e12/464_2020_7950_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/14ab/8263447/8fa7a936acf9/464_2020_7950_Fig4_HTML.jpg

相似文献

[1]
Length of Barrett's esophagus in the presence of low-grade dysplasia, high-grade dysplasia, and adenocarcinoma.

Surg Endosc. 2021-8

[2]
Risk of malignant progression in Barrett's esophagus indefinite for dysplasia.

Dis Esophagus. 2017-3-1

[3]
Increasing prevalence of high-grade dysplasia and adenocarcinoma on index endoscopy in Barrett's esophagus over the past 2 decades: data from a multicenter U.S. consortium.

Gastrointest Endosc. 2018-10-17

[4]
Risk stratification of patients with barrett's esophagus and low-grade dysplasia or indefinite for dysplasia.

Clin Gastroenterol Hepatol. 2014-8-4

[5]
Association between length of Barrett's esophagus and risk of high-grade dysplasia or adenocarcinoma in patients without dysplasia.

Clin Gastroenterol Hepatol. 2013-5-22

[6]
Patients With Barrett's Esophagus and Persistent Low-grade Dysplasia Have an Increased Risk for High-grade Dysplasia and Cancer.

Clin Gastroenterol Hepatol. 2015-12-31

[7]
A Tissue Systems Pathology Test Detects Abnormalities Associated with Prevalent High-Grade Dysplasia and Esophageal Cancer in Barrett's Esophagus.

Cancer Epidemiol Biomarkers Prev. 2017-2

[8]
Dysplasia in short-segment Barrett's esophagus: a prospective 3-year follow-up.

Am J Gastroenterol. 1997-11

[9]
Persistent confirmed low-grade dysplasia in Barrett's esophagus is a risk factor for progression to high-grade dysplasia and adenocarcinoma in a US Veterans cohort.

Dis Esophagus. 2020-3-5

[10]
Progression from low-grade dysplasia to malignancy in patients with Barrett's esophagus diagnosed by two or more pathologists.

World J Gastroenterol. 2016-10-21

引用本文的文献

[1]
High Risk of Persistence and Risk of Dysplasia After Diagnosis of Ultrashort Barrett's Esophagus.

Am J Gastroenterol. 2025-3-7

[2]
Irregular Z-Line: To Biopsy or Not to Biopsy?

Dig Dis Sci. 2024-8

[3]
Mechanisms and pathophysiology of Barrett oesophagus.

Nat Rev Gastroenterol Hepatol. 2022-9

[4]
Barrett's esophagus: results from an Italian cohort with tight endoscopic surveillance.

Acta Biomed. 2022-3-14

[5]
Endoscopic diagnosis and screening of Barrett's esophagus: Inconsistency of diagnostic criteria between Japan and Western countries.

DEN Open. 2021-11-15

[6]
Gastroesophageal Reflux Disease, Esophagitis, and Barrett's Esophagus 3 to 4 Years Post Sleeve Gastrectomy.

Obes Surg. 2021-12

本文引用的文献

[1]
Dysplasia in short-segment Barrett's esophagus: a prospective 3-year follow-up.

Am J Gastroenterol. 1997-11

[2]
Prospective long-term endoscopic and histological follow-up of short segment Barrett's esophagus: comparison with traditional long segment Barrett's esophagus.

Am J Gastroenterol. 1997-3

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