Weston A P, Krmpotich P T, Cherian R, Dixon A, Topalosvki M
Veterans Administration Medical Center, Kansas City, Missouri, USA.
Am J Gastroenterol. 1997 Mar;92(3):407-13.
Barrett's esophagus is associated with adenocarcinoma of the cardia and esophagus, regardless of its extent. The aim of this study was to compare the prevalence and incidence of dysplasia and adenocarcinoma in short segment and traditional long segment Barrett's esophagus.
Seventy-four patients with short segment Barrett's and 78 with traditional Barrett's entered the study.
There were no significant differences in age or gender between the two groups of patients with Barrett's esophagus. A greater percentage of patients with short segment barrett's were black (p = 0.04). The prevalence of dysplasia at diagnosis in patients with short segment Barrett's was 8.1% versus 24.4% in patients with traditional Barrett's (p < 0.007). Adenocarcinoma was noted at diagnosis only in patients with traditional Barrett's (p < 0.0005). Twenty-six patients with short segment Barrett's and 29 with traditional Barrett's were followed prospectively for 12-40 months. Dysplasia developed during follow-up in two patients with short segment Barrett's and in six patients with traditional Barrett's (p < 0.05). Neither high grade dysplasia nor cancer developed in any patients with short segment Barrett's. High grade dysplasia did develop in two patients with traditional Barrett's esophagus, and mucosal adenocarcinoma developed in one. The frequency of dysplasia on the latest surveillance examination continued to be significantly higher for patients with traditional Barrett's (p = 0.03). Follow-up surveillance biopsy specimens of Barrett's mucosa frequently demonstrated an absence of goblet cells in patients with short segment Barrett's compared with patients with traditional Barrett's (p < 0.0001).
The prevalence of dysplasia or adenocarcinoma and the incidence of dysplasia in patients with traditional Barrett's esophagus are significantly higher than in patients with short segment Barrett's esophagus. Further prospective surveillance is required to determine whether the incidence of adenocarcinoma in patients with short segment Barrett's esophagus is significantly lower.
无论病变范围如何，巴雷特食管均与贲门和食管癌相关。本研究旨在比较短节段和传统长节段巴雷特食管中发育异常和腺癌的患病率及发病率。
74例短节段巴雷特食管患者和78例传统巴雷特食管患者进入本研究。
两组巴雷特食管患者在年龄或性别上无显著差异。短节段巴雷特食管患者中黑人比例更高（p = 0.04）。短节段巴雷特食管患者诊断时发育异常的患病率为8.1%，而传统巴雷特食管患者为24.4%（p < 0.007）。仅在传统巴雷特食管患者诊断时发现腺癌（p < 0.0005）。26例短节段巴雷特食管患者和29例传统巴雷特食管患者进行了为期12 - 40个月的前瞻性随访。随访期间，2例短节段巴雷特食管患者和6例传统巴雷特食管患者出现发育异常（p < 0.05）。短节段巴雷特食管患者均未发生高级别发育异常或癌症。2例传统巴雷特食管患者发生高级别发育异常，1例发生黏膜腺癌。传统巴雷特食管患者在最近一次监测检查中发育异常的频率仍然显著更高（p = 0.03）。与传统巴雷特食管患者相比，短节段巴雷特食管患者巴雷特黏膜的随访监测活检标本中杯状细胞缺失的情况更为常见（p < 0.0001）。
传统巴雷特食管患者发育异常或腺癌的患病率以及发育异常的发病率显著高于短节段巴雷特食管患者。需要进一步的前瞻性监测来确定短节段巴雷特食管患者腺癌的发病率是否显著更低。
