Starnes V A, Adkins R B, Ballinger J F, Sawyers J L
Arch Surg. 1984 May;119(5):563-7. doi: 10.1001/archsurg.1984.01390170059012.
During a ten-year period, endoscopy demonstrated acid-peptic esophagitis in 439 patients. Forty of these patients (9.1%) had Barrett's esophagus. Adenocarcinoma was present in the columnar epithelium in 15 (37.5%) of the patients with Barrett's esophagus. Hiatal hernias, with symptoms of heartburn, dysphagia, stricture, and ulceration, were found in more than 75% of the patients with Barrett's esophagus. We developed a treatment algorithm. Patients with symptomatic reflux esophagitis should undergo endoscopy with biopsy. If Barrett's esophagus is diagnosed, an antireflux procedure should be performed, preferably a proximal gastric vagotomy with Nissen's fundoplication. Follow-up examination by endoscopy with biopsy and cytology should be performed every six months. Indications for early esophagectomy include progression of cellular dysplasia, carcinoma in situ, and a non-healing Barrett's ulcer following an antireflux procedure. Our data support an aggressive surgical treatment of patients with Barrett's esophagus.
在十年期间，内镜检查显示439例患者患有酸相关性食管炎。其中40例患者（9.1%）患有巴雷特食管。15例（37.5%）巴雷特食管患者的柱状上皮中存在腺癌。超过75%的巴雷特食管患者存在伴有烧心、吞咽困难、狭窄和溃疡症状的食管裂孔疝。我们制定了一种治疗方案。有症状的反流性食管炎患者应接受内镜检查并活检。如果诊断为巴雷特食管，应进行抗反流手术，最好是近端胃迷走神经切断术加nissen胃底折叠术。应每六个月进行一次内镜检查并活检及细胞学检查的随访。早期食管切除术的指征包括细胞异型增生进展、原位癌以及抗反流手术后不愈合的巴雷特溃疡。我们的数据支持对巴雷特食管患者进行积极的手术治疗。
