IMportance of an Irregular Z Line: Is Barrett's in the Eye of the Beholder?
IMportance of an Irregular Z Line: Is Barrett's in the Eye of the Beholder?
复制标题
不规则 Z 线的重要性：巴雷特氏症是情人眼里出西施吗？
DOI：
10.1007/s10620-018-4998-3
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发表时间：
2018
影响因子：
3.1
通讯作者：
Shaheen,NicholasJ
中科院分区：
文献类型：
--
作者：
Eluri,Swathi;Shaheen,NicholasJ
Z线划定了鳞状柱状交界处（SCJ），即从鳞状食管黏膜过渡到衬胃的柱状粘膜，或者在巴雷特食管的情况下，介于鳞状上皮和未肠化的柱状上皮的化生段之间。不规则的Z线以< 1厘米的柱状舌为特征，并延伸至胃食管交界处近端，据报道，大约10-15%的上内镜患者出现了这一发现[1,2]。在Z线不规则的人群中，肠化生（IM）[3]的患病率高达44%。然而，这一发现对于不规则Z线和IM患者进展为瘤变风险的临床意义尚不清楚。虽然先前的指南与假定的巴雷特食管（BE）段< 1厘米的管理策略存在冲突，但最新的美国胃肠病学学会（ACG）指南[5]建议不要从不规则的Z线进行活检，这一建议是由于内窥镜检查结果的标准化程度较低（一个内窥镜医生的正常Z线可能是另一个人的不规则Z线），与此相关的额外费用。患者焦虑的可能性，以及在这些病变中发现的普遍和偶发的发育不良和食管腺癌（EAC）的低发生率。此外，携带IM的不规则Z线患者可能会被纳入内窥镜监测方案，这需要反复进行内窥镜监测的成本和不便
The Z line demarcates the squamocolumnar junction (SCJ), the transition from the squamous esophageal mucosa to the columnar mucosa lining the stomach, or in cases of Barrett’s esophagus, between the squamous and intestinalized columnar epithelium of the metaplastic segment. An irregular Z line is characterized by< 1 cm columnar tongues that extend proximal to the gastroesophageal junction, a finding that has been reported in approximately 10–15% of the population undergoing upper endoscopy [1, 2]. In those with an irregular Z line, there is up to a 44% prevalence of intestinal metaplasia (IM)[3]. Nevertheless, the clinical significance of this finding with respect to the risk of progression to neoplasia in patients with an irregular Z line and IM is unclear [4].While prior guidelines are in conflict with regard to the management strategies for putative Barrett’s esophagus (BE) segments< 1 cm, the most recent American College of Gastroenterology (ACG) guidelines [5] recommend against obtaining biopsies from an irregular Z line, a recommendation made due to the poor endoscopic standardization of this finding (one endoscopist’s normal Z line is another’s irregular Z line), the additional costs associated with this practice, the potential for patient anxiety, and the low rates of prevalent and incident dysplasia and esophageal adenocarcinoma (EAC) found in these lesions. Also, patients with an irregular Z line who harbor IM might be enrolled in endoscopic surveillance protocols, necessitating the costs and inconvenience of recurrent surveillance endoscopy, as