DeMeester S R, Campos G M, DeMeester T R, Bremner C G, Hagen J A, Peters J H, Crookes P F
Department of Surgery, University of Southern California School of Medicine, Los Angeles, USA.
Ann Surg. 1998 Oct;228(4):547-56. doi: 10.1097/00000658-199810000-00011.
The aim of this study was to determine whether antireflux surgery is more effective in producing loss of intestinal metaplasia located only at the gastroesophageal junction than it has been in patients with intestinal metaplasia extending up into the distal esophagus.
Biopsies of a normal appearing gastroesophageal junction will demonstrate cardiac mucosa containing goblet cells--the hallmark of intestinal metaplasia--in 10% to 15% of patients who are evaluated for symptoms of gastroesophageal reflux. The incidence of adenocarcinoma of the esophagus and cardia is rising faster than any other cancer in America, and most of these cancers are found adjacent to areas of intestinal metaplasia. Antireflux surgery in patients with Barrett's esophagus may provide protection from progression to dysplasia and cancer; however, it does not reliably cause regression of the intestinal metaplasia. Less is known about the potential for intestinal metaplasia limited to the cardia (CIM) to regress.
Sixty patients with intestinal metaplasia of the esophagus or cardia had antireflux surgery. Patients in the intestinal (CIM) group (n = 15) had no endoscopically visible segment of columnar epithelium. Patients in the Barrett's group (n = 45) had columnar epithelium visible within the esophagus. Median follow-up was 25 months in each group.
Postoperative biopsies showed complete loss of intestinal metaplasia in 73% of the patients with CIM compared with 4.4% of the patients with Barrett's. Low-grade dysplasia, present in 10 patients preoperatively, regressed in 7 patients (70%). No patient progressed to high-grade dysplasia or cancer.
Loss of intestinal metaplasia after antireflux surgery is rare in patients with Barrett's, but occurred in most patients with CIM. This suggests that cardiac epithelium is dynamic and that microscopic areas of intestinal metaplasia are able to regress much more frequently than longer, visible segments of intestinal metaplasia.
本研究旨在确定抗反流手术对于仅位于胃食管交界处的肠化生的消除效果是否优于对肠化生向上延伸至食管远端的患者。
对表现正常的胃食管交界处进行活检时，在因胃食管反流症状接受评估的患者中，10%至15%会显示含有杯状细胞的贲门黏膜，这是肠化生的标志。在美国，食管和贲门腺癌的发病率增长速度超过其他任何癌症，并且这些癌症大多发现于肠化生区域附近。巴雷特食管患者进行抗反流手术可能有助于预防进展为发育异常和癌症；然而，它并不能可靠地使肠化生消退。对于局限于贲门的肠化生（CIM）消退的可能性了解较少。
60例食管或贲门肠化生患者接受了抗反流手术。肠化生（CIM）组（n = 15）患者内镜下未见柱状上皮段。巴雷特组（n = 45）患者食管内可见柱状上皮。每组的中位随访时间为25个月。
术后活检显示，CIM组73%的患者肠化生完全消失，而巴雷特组这一比例为4.4%。术前10例患者存在低度发育异常，其中7例（70%）消退。无患者进展为高度发育异常或癌症。
抗反流手术后，巴雷特食管患者的肠化生很少消失，但大多数CIM患者的肠化生会消失。这表明贲门上皮是动态的，微观的肠化生区域比更长的、可见的肠化生段更频繁地能够消退。
