早期巴雷特食管腺癌临床、内镜、病理特征和内镜黏膜下剥离术治疗效果

Clinical, endoscopic and pathological features of early Barrett esophageal adenocarcinoma and its treatment efficacy by endoscopic submucosal dissection

摘要:

目的 探讨早期巴雷特食管腺癌（Barrett esophageal adenocarcinoma，BEA）的临床、内镜和病理特征，并评价内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）对其治疗效果。方法 2015年11月至2018年6月，在北京友谊医院确诊早期BEA，并行ESD治疗的13例病例纳入回顾性分析，对其临床资料、内镜资料和病理资料进行收集和分析。结果 13例患者中，男性10例。巴雷特食管：长段1例，短段和超短段（短于1 cm）各6例；全周型2例，舌型11例。内镜下10例位于食管胃结合部右前方（12～2点钟方位），0-Ⅱ型（浅表平坦型）12例，13例均成功完成ESD治疗，整块切除率100%（13/13），治愈性切除率为92%（12/13），无治疗相关并发症。术后病理高分化9例；黏膜内癌10例。随访11例，随访时间33～293个月，未见复发者。结论 13例早期BEA患者中，男性、非长段和舌状巴雷特食管患者为主，病灶多位于食管胃结合部的右前方，内镜下以浅表平坦型为主，病理多为高分化腺癌，多局限于黏膜层，ESD治疗安全有效。

Abstract:

Objective To investigate the clinical, endoscopic and pathological characteristics of early Barrett esophageal adenocarcinoma (BEA) and to evaluate the treatment efficacy of endoscopic submucosal dissection (ESD). Methods Data of 13 patients who were diagnosed as early BEA and treated by ESD in Beijing Friendship Hospital from November 2015 to June 2018 were retrospectively analyzed, including clinical data, endoscopic manifestations and pathological information. Results Out of 13 patients, 10 were male. One had underlying long-segment Barrett esophagus (LSBE), 6 had short-segment Barrett esophagus (SSBE), and 6 had super short-segment Barrett esophagus (less than 1 cm). Two arose from circumferential Barrett esophageal (BE) and 11 from tongue-like BE. Ten lesions were located on the right anterior side wall (12-2 o′clock) of the esophagogastric junction (EGJ), and 12 lesions were superficial type (0-Ⅱ). ESD was successfully conducted in all the patients without any complication. The en bloc and curative resection rate was 100% (13/13) and 92% (12/13), respectively. Pathology examination found 9 well-differentiated adenocarcinoma and 10 intramucosal cancer. No recurrence was detected in 11 patients during follow-up of 33-293 months. Conclusion Early BEA tends to occur in elderly male, and mostly originated from non-LSBE and tongue-like BE. Most lesions are superficial type and located on the right anterior side wall of EGJ. In pathology, most lesions are well-differentiated adenocarcinoma and limited to the mucosa. ESD is a safe and efficient treatment for BEA.