Detection and staging of esophageal cancers within Barrett's esophagus is improved by assessment in specialized Barrett's units
Detection and staging of esophageal cancers within Barrett's esophagus is improved by assessment in specialized Barrett's units
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DOI：
10.1016/j.gie.2014.03.051
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发表时间：
2014-12-01
影响因子：
7.7
通讯作者：
Taylor, Andrew C.
中科院分区：
文献类型：
--
作者：
Cameron, Georgina R.;Jayasekera, Chatura S.;Taylor, Andrew C.
背景：粘膜异常的识别和切除对于治疗发育不良巴雷特食管 (BE) 至关重要，因为这些区域可能含有食管腺癌 (EAC)。目的：比较社区和 BE 单位中发育不良 BE 的粘膜病变和 EAC 检出率，并评估 EMR 对疾病分期和管理的影响。设计：前瞻性队列研究。设置： 三级转诊中心。患者：发育不良 BE 患者。干预措施：使用高清白光内窥镜 (HD-WLE)、窄带成像 (NBI) 和西雅图方案活检进行重新评估。对被认为含有肿瘤的病变进行 EMR。审查转诊组织学和内窥镜检查。主要结果测量：BE 单位与社区的粘膜病变和 EAC 检出率。 EMR 对管理的影响。结果：69 名患者被转诊（88% 为男性；中位年龄 69 岁）。转诊时，HD-WLE/NBI 使用率为 57%/ 14%，西雅图协议遵守率为 20%。十八名患者患有粘膜内癌。 BE 科室中有 65 名患者检测到病变，而转诊时有 29 名患者检测到病变（P
Background: Identification and resection of mucosal abnormalities are critical in managing dysplastic Barrett's esophagus (BE) because these areas may harbor esophageal adenocarcinoma (EAC).Objectives: To compare mucosal lesion and EAC detection rates in dysplastic BE in the community versus a BE unit and assess the impact of EMR on disease staging and management.Design: Prospective cohort study.Setting: Tertiary referral center. Patients: Patients with dysplastic BE.Interventions: Reassessment with high-definition white-light endoscopy (HD-WLE), narrow-band imaging (NBI), and Seattle protocol biopsies. EMR performed in lesions thought to harbor neoplasia. Review of referral histology and endoscopies.Main Outcome Measurements: Mucosal lesion and EAC detection rates in a BE unit versus the community. Impact of EMR on management.Results: Sixty-nine patients were referred (88% male; median age, 69 years). At referral, HD-WLE/NBI usewas 57%/ 14%, and Seattle protocol adherence was 20%. Eighteen patients had intramucosal cancer. Lesions were detected in 65 patients in the BE unit versus 29 patients at referral (P