短节段巴雷特食管的发育异常：一项为期3年的前瞻性随访研究
Dysplasia in short-segment Barrett's esophagus: a prospective 3-year follow-up.
作者信息
Sharma P, Morales T G, Bhattacharyya A, Garewal H S, Sampliner R E
机构信息
Section of Gastroenterology, Arizona Health Sciences Center, Tucson 85723, USA.
出版信息
Am J Gastroenterol. 1997 Nov;92(11):2012-6.
OBJECTIVE
Short segments of intestinal metaplasia in the distal esophagus are being recognized with increasing frequency. Both long and short segments of Barrett's esophagus can progress to dysplasia and cancer. However, the risk of short-segment Barrett's esophagus (SSBE) for the development of dysplasia and adenocarcinoma of the esophagus is not yet known. Our purpose, therefore, was to determine the frequency with which dysplasia occurs in patients with SSBE.
METHODS
Patients with SSBE were followed prospectively for the development of dysplasia. SSBE was defined as <3 cm of Barrett's-appearing epithelium above the gastroesophageal junction at endoscopy, with intestinal metaplasia on biopsy as documented by alcian blue stain at pH 2.5 on at least two endoscopic biopsies 6 months apart. Patients had interval upper endoscopy with systematic biopsy of the Barrett's segment.
RESULTS
Fifty-nine SSBE patients were identified. The mean length of Barrett's mucosa was 1.5 +/- 0.1 cm; the mean age of the patients was 63.1 +/- 1.3 yr. Five patients had low-grade dysplasia (LGD) at initial endoscopy, for a prevalence of 8.5%; none had high grade dysplasia (HGD). Thirty-two patients had follow-up endoscopy over a mean period of 36.9 +/- 5.4 months. Five of these patients developed dysplasia on follow-up, three with LGD and two with HGD, the incidence of any dysplasia being 5.7% per year. One patient with HGD that developed during surveillance progressed to adenocarcinoma of the esophagus over a 2-yr period. The other patient with HGD had LGD on follow-up endoscopy. Six patients with initial LGD had no evidence of dysplasia on follow-up.
CONCLUSIONS
The prevalence of dysplasia was 8.5% with an incidence of 5.7% per year in this group of SSBE patients, followed prospectively. Although dysplastic changes may not be identified on follow-up examination, some patients progress to adenocarcinoma. Therefore, we recommend surveillance endoscopy and biopsy in patients with SSBE just as in those with long-segment Barrett's esophagus.
目的
远端食管短段肠化生的发现频率日益增加。巴雷特食管的长段和短段均可进展为发育异常和癌症。然而，短段巴雷特食管（SSBE）发生食管发育异常和腺癌的风险尚不清楚。因此，我们的目的是确定SSBE患者中发育异常的发生频率。
方法
对SSBE患者进行前瞻性随访，观察发育异常的发生情况。SSBE定义为内镜检查时食管胃交界处上方出现巴雷特样上皮长度<3 cm，活检显示肠化生，通过pH 2.5的阿尔辛蓝染色记录，至少两次内镜活检间隔6个月。患者定期进行上消化道内镜检查，并对巴雷特段进行系统活检。
结果
共识别出59例SSBE患者。巴雷特黏膜的平均长度为1.5±0.1 cm；患者的平均年龄为63.1±1.3岁。5例患者在初次内镜检查时出现低级别发育异常（LGD），患病率为8.5%；无高级别发育异常（HGD）患者。32例患者接受了平均36.9±5.4个月的随访内镜检查。其中5例患者在随访中出现发育异常，3例为LGD，2例为HGD，任何发育异常的年发生率为5.7%。1例在监测期间出现HGD的患者在2年内进展为食管腺癌。另1例HGD患者在随访内镜检查时为LGD。6例初始为LGD的患者在随访中无发育异常证据。
结论
在这组前瞻性随访的SSBE患者中，发育异常的患病率为8.5%，年发生率为5.7%。尽管随访检查可能未发现发育异常改变，但部分患者会进展为腺癌。因此，我们建议对SSBE患者进行监测内镜检查和活检，就如同对长段巴雷特食管患者一样。
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