Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China.
Department of Pathology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China.
J Dig Dis. 2021 Sep;22(9):520-528. doi: 10.1111/1751-2980.13039. Epub 2021 Sep 2.
Esophageal white lesions (EWL) are commonly observed under upper endoscopy, while their clinical significance remains undetermined. The aim of this study was to identify the endoscopic characteristics of EWL and distinguish between different types of EWL.
Consecutive patients with upper gastrointestinal complaints and participants admitted for health check-up who underwent esophagogastroduodenoscopy from October 2018 to August 2019 in a tertiary hospital were prospectively screened. EWL were detected under endoscopy and biopsy was performed for histological analysis. Participants' characteristics, lifestyle, esophageal motility and reflux monitoring variables were analyzed.
Of the 3641 consecutive participants screened, 303 of them aged 56.12 ± 10.95 years were found to have EWL (detection rate of 8.3%). More than one-third of them preferred hot drinks, eating pickled or spicy food, smoking and alcohol consumption and 5.3% had current or former upper gastrointestinal or head and neck cancers. The common endoscopic appearance of the EWL (2.9 mm ± 1.2 mm in diameter) included slightly elevated plaque, translucent white in color, with a clear border, round or oval in shape, and a scaly, rough or smooth surface. Histology showed low-grade intraepithelial dysplasia in 13 cases, leukoplakia in 10 and intestinal metaplasia in one. No significant differences were found between the histological findings and endoscopic manifestations of EWL.
EWL are not uncommon in daily endoscopic examination, with some of them being precancerous lesions. Conventional white-light endoscopy is insufficient to identify EWL, while histological assessment is important. Further studies using advanced endoscopic techniques with long-term follow-up are needed.
食管白色病变（EWL）在上消化道内镜检查中较为常见，但其临床意义尚未确定。本研究旨在确定 EWL 的内镜特征，并区分不同类型的 EWL。
连续筛选 2018 年 10 月至 2019 年 8 月在一家三级医院因上消化道症状和健康检查接受食管胃十二指肠镜检查的患者。在内镜下检测 EWL 并进行活检进行组织学分析。分析参与者的特征、生活方式、食管动力和反流监测变量。
在连续筛查的 3641 名参与者中，发现 303 名年龄为 56.12±10.95 岁的患者存在 EWL（检出率为 8.3%）。其中超过三分之一的人喜欢喝热饮、吃腌制或辛辣食物、吸烟和饮酒，5.3%的人有现患或既往上消化道或头颈部癌症。EWL 的常见内镜表现（直径 2.9±1.2mm）包括稍高的斑块、半透明白色、边界清晰、圆形或椭圆形、鳞片状、粗糙或光滑表面。组织学检查显示 13 例为低级别上皮内瘤变，10 例为白斑，1 例为肠上皮化生。EWL 的组织学表现与内镜表现之间无显著差异。
EWL 在日常内镜检查中并不少见，其中一些是癌前病变。常规白光内镜不足以识别 EWL，而组织学评估很重要。需要进一步使用先进的内镜技术并进行长期随访的研究。
