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检测时间较长与Barrett 食管中高度不典型增生和食管腺癌的检测率增加有关

发布日期:2014-1-29 12:40:49 文章来源:ENDOSCOPY 作者次数:1375
    背景

    目前指导方针推荐采用严格的活检方案进行Barrett 食管(BE)的内镜检测。然而,我们仍需要新型方法,以提高BE检测。

    目的

    评估Barrett食管检测时间(BIT)对检测率的影响。

    设计

    临床试验所得数据的事后分析。

    环境

    5所三级转诊中心。

    患者

    接受BE检测的患者。

    干预

    协调者采用秒表前瞻性记录了检测BE黏膜所花费的时间。

    主要测量指标

    内镜下的疑似病变、高度不典型增生(HGD/食管腺癌(EAC)。

    结果

    11 位独立的内镜师对共112例患者进行了内镜检查。结果发现,Barrett食管检测时间较长的患者患内镜下疑似病变的可能性更大(P < 0.001),而且患内镜下疑似病变的数量更多(P =0 .0001),因此这些患者接受了HGD/EAC诊断(P =0 .001)。内镜师对每厘米BE的平均BITHGD/EAC患者的检测直接相关(ρ =0 .63, P = 0.03)。对每厘米BE的检测时间超过1分钟的的内镜师检测出的携带内镜下疑似病变的患者较多(4.2% 13.3%P =0.04),同时对HGD/EAC的检测率较高(40.2% 6.7%P = 0.06)。

    局限性

    在三级转诊中心,事后分析大量的研究人群和经验丰富的内镜师。

    结论

    检测BE片段花费时间较长,这与HGD/EAC的检测率增加有关。花费更多的时间对BE黏膜进行全面的检查,可能会作为一种提高BE检测率的简单且可广泛应用的方法。

    缩写词BEBarrett食管;BITBarrett食管检测时间;EAC,食管腺癌;HD-WLE,高清晰度白光内窥镜检查;HGD,高度不典型增生;IM,肠上皮化生;LGD,低度异型增生


     

    Longer inspection time is associated with increased detection of high-grade dysplasia and esophageal adenocarcinoma in Barretts esophagus

    Presented in part as an oral presentation at Digestive Disease Week, May 7-10, 2011, Chicago, Illinois (Gastroenterology 2011;140(5 Suppl 1):S198-9).

    Background

    Current guidelines recommend that endoscopic surveillance of Barretts esophagus (BE) be performed by using a strict biopsy protocol. However, novel methods to improve BE surveillance are still needed.

    Objective

    To evaluate the impact of Barretts inspection time (BIT) on yield of surveillance.

    Design

    Post hoc analysis of data obtained from a clinical trial.

    Setting

    Five tertiary referral centers.

    Patients

    Patients undergoing BE surveillance.

    Interventions

    Coordinators prospectively recorded the time spent inspecting the BE mucosa with a stopwatch.

    Main Outcome Measurements

    Endoscopically suspicious lesions, high-grade dysplasia (HGD)/esophageal adenocarcinoma (EAC).

    Results

    A total of 112 patients underwent endoscopic surveillance by 11 individual endoscopists. Patients with longer BITs were more likely to have an endoscopically suspicious lesion (P < .001) and more endoscopically suspicious lesions (P = .0001) and receive a diagnosis of HGD/EAC (P = .001). There was a direct correlation between the endoscopists mean BIT per centimeter of BE and the detection of patients with HGD/EAC (ρ = .63, P = .03). Endoscopists who had an average BIT longer than 1 minute per centimeter of BE detected more patients with endoscopically suspicious lesions (54.2% vs 13.3%, P = .04), and there was a trend toward a higher detection rate of HGD/EAC (40.2% vs 6.7%, P = .06).

    Limitations

    Post hoc analysis of an enriched study population and experienced endoscopists at tertiary referral centers.

    Conclusions

    Longer time spent inspecting the BE segment is associated with the increased detection of HGD/EAC. Taking additional time to perform a thorough examination of the BE mucosa may serve as an easy and widely available method to improve the yield of BE surveillance.

    Abbreviations:  BE, Barretts esophagus, BIT, Barretts inspection time, EAC, esophageal adenocarcinoma, HD-WLE, high-definition white-light endoscopy, HGD, high-grade dysplasia, IM, intestinal metaplasia, LGD, low-grade dysplasia

     

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