设为首页 | 加入收藏
| 欢迎光临本站!

消化内镜学分会官方网站

当前位置:文献追踪 > 国内外期刊

圆周定位预测短节段Barrett食管患者患高度异型增生和早期腺癌的风险

发布日期:2014-1-29 12:40:37 文章来源:GIE 作者次数:1347

     圆周定位预测短节段Barrett食管患者患高度异型增生和早期腺癌的风险

    提交于2010年澳大利亚昆士兰州Gold Coast胃肠病周(胃肠病肝脏病学杂志201025 [增刊 3]A68)与2011伊利诺伊州芝加哥市消化疾病周(消化内镜201173:AB200)。

    背景

    目前对早期Barrett食管瘤是否易发于短节段疾病中的特定间隙部位的情况仍不清楚。因为黏膜酸暴露水平不同,所以解剖学因素在确定病变部位中发挥着作用。

    目的

    识别对监测方案具有重要意义的高风险病变部位。

    设计

    我们审查了Barrett食管瘤患者的前瞻性维护数据库,这些患者是在2所澳大利亚三级中心接受内镜切割术(ER)。我们对内镜切除的靶向病变进行了表征,也对它们在食管中的部位进行标记,并将作为一个钟面。比例Z检验用于测试病变分布的均匀性误差。

    环境

    2所澳大利亚三级中心。

    患者

    接受过内镜切除的Barratt食管瘤患者。

    主要测量指标

    食管远端病变定位,切除标本组织学。

    结果

    146例患者为治疗经活检证实的高度异型增生或食管腺癌而接受了内镜切割术。共75例患者的Barrett食管切割段长度不大于5 cm,且这些患者具有一处可见病变。5例患者共有80处病变,其中,2处病变可见。66例病变(82.5%)的内镜切除样本经高级病理学鉴别:37例高度异型增生(46%),24例黏膜腺癌(30%),5例黏膜下腺癌(6%)。在共80例病变中,43例(53.8%)(95%置信区间:42.9%-64.7)病变集中于25点钟的弧线内,涵盖了周长的25%。经高级病理学鉴别,此面积也占到总病变面积的54.5% (即,36/66)(95%置信区间:42.5%-66.5%)。所有置信区间均处于预期的均匀圆形分布的25%以上(P < 0.05)。

    局限性

    在一所三级研究中心进行的观察性研究。

    结论

    5 cm5 cm以内的Barrett最大片段中,25点钟弧线约占肉眼可见病变和相关早期肿瘤的50%。这个发现对监测方案有着重要意义。

    缩写词BE,巴雷特食管;CBE,巴雷特食管完整切除;EAC,食管腺癌ER内镜下切除;GEJ,胃食管结合处;HGD,高度异型增生;LSBE长节段巴雷特食管;SSBE,短节段巴雷特食管


    Circumferential location predicts the risk of high-grade dysplasia and early adenocarcinoma in short-segment Barretts esophagus


    Presented at Australian Gastroenterology Week, Gold Coast, QLD, Australia, 2010 (J Gastroenterol Hepatol 2010;25[suppl 3]:A68), and Digestive Disease Week, Chicago, Illinois, 2011 (Gastrointest Endosc 2011;73:AB200).

    Background        

    Whether early Barretts neoplasia has a predilection for particular spatial locations in shorter segment disease is currently unknown. Anatomic factors may play a role in lesion location because of differing levels of mucosal acid exposure.

    Objective

    To identify high-risk lesion locations, which has important implications for surveillance strategies.

    Design

    We interrogated a prospectively maintained database of patients who underwent endoscopic resection (ER) for Barrett’s neoplasia at 2 Australian tertiary centers. Lesions targeted for ER were characterized and their location in the distal esophagus was noted as on a clock face. A Z test of proportions was used to test for deviation from uniformity in the distribution of lesions.

    Setting

    Two Australian tertiary centers.

    Patients

    Patients who underwent ER for Barrett’s neoplasia.

    Main Outcome Measurements

    Lesion location in the distal oesophagus, resected specimen histology.

    Results

    A total of 146 consecutive patients had ER for biopsy-proven high-grade dysplasia or esophageal adenocarcinoma. A total of 75 patients had Barretts segment length of5 cmor less and a visible lesion. Five patients had 2 visible lesions giving a total of 80 lesions. ER of 66 lesions (82.5%) led to the identification of advanced pathology: 37 high-grade dysplasia (46%), 24 mucosal adenocarcinoma (30%), 5 submucosal adenocarcinoma (6%). Of a total of 80 lesions, 43 (53.8%) (95% CI, 42.9%-64.7%) were centered within the 2- to 5-oclock arc, comprising 25% of the circumference. This area also accounted for 36 (54.5%) of the 66 lesions with advanced histology (95% CI, 42.5%-66.5%). All confidence intervals lie wholly above the 25% expected in a uniform circular distribution (P < .05).

    Limitations

    Observational study in a tertiary center.

    Conclusions

    In Barretts maximal segments of5 cmor less, the 2- to 5-oclock arc, accounts for approximately 50% of macroscopically visible lesions and associated early neoplasia. This finding has important implications for surveillance strategies.

    Abbreviations:  BE, Barretts esophagus, CBE, complete Barretts excision, EAC, esophageal adenocarcinoma, ER, endoscopic resection, GEJ, gastroesophageal junction, HGD, high-grade dysplasia, LSBE, long-segment Barretts esophagus, SSBE, short-segment Barretts esophagus

    (作者:)
相关评论
用户名: 登录