Ishimura Norihisa, Okimoto Eiko, Shibagaki Kotaro, Ishihara Shunji
Second Department of Internal Medicine Shimane University Faculty of Medicine Shimane Japan.
Division of Gastrointestinal Endoscopy Shimane University Hospital Shimane Japan.
DEN Open. 2021 Nov 15;2(1):e73. doi: 10.1002/deo2.73. eCollection 2022 Apr.
Barrett's esophagus (BE) is an endoscopically identifiable premalignant condition for esophageal adenocarcinoma (EAC). To diagnose BE precisely, careful inspection of the anatomic landmarks, including the esophagogastric junction and the squamocolumnar junction is important. The distal end of the palisade vessels and the proximal end of the gastric folds are used as the landmark of the esophagogastric junction in endoscopic diagnosis, with the latter solely used internationally, except in some Asian countries, including Japan. In addition, the diagnostic criteria adopted internationally for BE are inconsistent, particularly between Japan and Western countries. Recently updated guidelines in Western countries have included length criteria, with a 1-cm threshold of columnar epithelium by endoscopic observation and/or histologic confirmation of the presence of specialized intestinal metaplasia. Since BE is endoscopically diagnosed at any length without histologic assessment in Japan, the reported prevalence of short-segment BE is very high in Japan compared with that in Western countries. Although guidelines on screening exist for BE, the current strategies based on the presence of chronic gastroesophageal reflux disease with multiple risk factors may miss the opportunity for early detection of EAC. Indeed, up to 40% of patients with EAC have no history of chronic gastroesophageal reflux disease. To discuss BE on the same footing worldwide, standardization of diagnostic criteria, screening indication, and establishment of effective techniques for detecting dysplastic lesions are eagerly awaited. Japanese guidelines for BE should be revised regarding the length criteria, including the minimum length and long-segment BE, in line with the recently updated Western guidelines.
巴雷特食管（BE）是一种在内镜下可识别的食管腺癌（EAC）癌前病变。为了精确诊断BE，仔细检查包括食管胃交界和鳞柱状上皮交界在内的解剖标志非常重要。在内镜诊断中，栅栏状血管的远端和胃皱襞的近端被用作食管胃交界的标志，除了包括日本在内的一些亚洲国家外，国际上仅使用后者。此外，国际上采用的BE诊断标准并不一致，尤其是在日本和西方国家之间。西方国家最近更新的指南纳入了长度标准，即通过内镜观察和/或组织学证实存在特殊肠化生时，柱状上皮的阈值为1厘米。由于在日本，BE是在内镜下不论长度进行诊断而无需组织学评估，因此与西方国家相比，日本报告的短段BE患病率非常高。尽管存在BE的筛查指南，但目前基于存在多种危险因素的慢性胃食管反流病的策略可能会错过早期发现EAC的机会。事实上，高达40%的EAC患者没有慢性胃食管反流病病史。为了在全球范围内统一讨论BE，迫切需要诊断标准的标准化、筛查指征以及建立检测发育异常病变的有效技术。日本关于BE的指南应根据西方国家最近更新的指南，对长度标准进行修订，包括最短长度和长段BE。
