Barham C P, Jones R L, Biddlestone L R, Hardwick R H, Shepherd N A, Barr H
Gloucester Gastroenterology Group, Gloucestershire Royal and Cranfield University Institute of Medical Sciences, Gloucestershire Royal Hospital, UK.
Gut. 1997 Sep;41(3):281-4. doi: 10.1136/gut.41.3.281.
Barrett's oesophagus is acquired by severe gastro-oesophageal reflux and is a premalignant condition. Acid suppression or anti-reflux surgery alone do not cause significant regression of the metaplastic mucosa nor reduce the malignant potential. Recent reports have suggested that the combination of mucosal ablation with acid suppression may result in squamous regeneration.
To destroy Barrett's mucosa by thermal ablation (in the setting of acid suppression) and so induce squamous regeneration.
Sixteen patients with non-dysplastic Barrett's oesophagus were recruited from a surveillance programme. All had been on a proton pump inhibitor.
At intervals, non-circumferential areas of columnar mucosa were ablated using the KTP laser. Acid suppression was obtained with 40 mg omeprazole daily. Multiple biopsy specimens were obtained for histological examination from ablated areas.
Ablation of all areas of glandular mucosa resulted in squamous regeneration. The number of treatments required depended on the length of the Barrett's segment. In 11 patients there was evidence of squamous regeneration over remaining Barrett's glands (in some of the post-treatment biopsy specimens) whilst in nine patients squamous metaplasia was seen within Barrett's glands.
Mucosal ablation of Barrett's oesophagus by laser, in the setting of acid suppression, results in squamous regeneration (though some burying of Barrett's glands did occur).
巴雷特食管是由严重的胃食管反流引起的一种癌前病变。单独使用抑酸或抗反流手术并不能使化生黏膜显著消退，也不能降低恶变潜能。最近的报告表明，黏膜消融与抑酸联合应用可能导致鳞状上皮再生。
通过热消融（在抑酸的情况下）破坏巴雷特黏膜，从而诱导鳞状上皮再生。
从一项监测项目中招募了16例无发育异常的巴雷特食管患者。所有患者均已服用质子泵抑制剂。
每隔一段时间，使用KTP激光对柱状黏膜的非环形区域进行消融。每天服用40mg奥美拉唑进行抑酸。从消融区域获取多个活检标本进行组织学检查。
所有腺性黏膜区域的消融均导致鳞状上皮再生。所需的治疗次数取决于巴雷特段的长度。11例患者在剩余的巴雷特腺体中有鳞状上皮再生的证据（在一些治疗后的活检标本中），而9例患者在巴雷特腺体内可见鳞状化生。
在抑酸的情况下，通过激光对巴雷特食管进行黏膜消融可导致鳞状上皮再生（尽管确实发生了一些巴雷特腺体被包埋的情况）。
