Moond Vishali, Yarra Pradeep, Bhatia Mannat, Malik Sheza, Malavarappu Vineel, Ali Hassam, Chandan Saurabh, Adler Douglas G, Mohan Babu P
Department of Internal Medicine, Saint Peter's University Hospital/Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Department of Gastroenterology & Hepatology, Saint Louis University, St. Louis, MO, USA.
Clin Endosc. 2025 May;58(3):377-385. doi: 10.5946/ce.2024.211. Epub 2025 Mar 31.
BACKGROUND/AIMS: The irregular Z-line, defined as a segment of columnar mucosa less than 1 cm in the distal esophagus, is often biopsied despite guidelines advising against it due to a low risk of progression to esophageal adenocarcinoma (EAC). However, the clinical significance of an irregular Z-line remains unclear. This meta-analysis examines the prevalence of Barrett's esophagus, dysplasia, and EAC in patients with an irregular Z-line.
We searched Medline, Embase, and Scopus databases up to October 2023 for studies on the prevalence of Barrett's esophagus, dysplasia, and EAC in these patients. A random-effects model was used for meta-analysis, and heterogeneity was assessed using I2 statistics.
Nine studies involving 17,637 patients were analyzed. Among those with an irregular Z-line, the prevalence of intestinal metaplasia was 29.4%. In patients with intestinal metaplasia, dysplasia was found in 6.2%, low-grade dysplasia in 5.9%, high-grade dysplasia in 1.6%, and EAC in 1.5%. These rates were higher compared to those without intestinal metaplasia.
Patients with an irregular Z-line and intestinal metaplasia may be at higher risk and could benefit from endoscopic surveillance. Further studies are needed to determine the necessity of biopsying irregular Z-lines.
背景/目的：不规则Z线定义为远端食管柱状黏膜段小于1厘米，尽管指南因进展为食管腺癌（EAC）风险低而不建议活检，但仍常进行活检。然而，不规则Z线的临床意义仍不明确。本荟萃分析探讨不规则Z线患者中巴雷特食管、发育异常和EAC的患病率。
我们检索了截至2023年10月的Medline、Embase和Scopus数据库，以查找关于这些患者中巴雷特食管、发育异常和EAC患病率的研究。采用随机效应模型进行荟萃分析，并使用I2统计量评估异质性。
分析了9项涉及17637名患者的研究。在有不规则Z线的患者中，肠化生患病率为29.4%。在肠化生患者中，发育异常发生率为6.2%，低级别发育异常为5.9%，高级别发育异常为1.6%，EAC为1.5%。与无肠化生的患者相比，这些比率更高。
有不规则Z线和肠化生的患者可能风险更高，可能受益于内镜监测。需要进一步研究以确定对不规则Z线进行活检的必要性。
