Barrett食管的临床认识

Clinical interpretation of Barrett's esophagus

Barrett食管(BE)是指食管下段复层鳞状上皮被化生的柱状上皮所取代的病理现象,是食管腺癌的癌前病变。BE在内镜下按化生柱状上皮的长度分为长段(≥3cm)和短段(<3cm),亦可按布拉格的标准,即根据环周型的范围和最大长度进行分类。为证实化生上皮或肿瘤性病变的存在,应在内镜下活检,行病理检查。对不伴有异型增生的BE患者应每2年接受1次内镜复查,如果2次复查后未检出异型增生和早期癌,可以酌情将复查间隔放宽为3年,而对重度异型增生的BE,应考虑内镜下切除或外科治疗。

Summary ： Barrett＇s esophagus （ BE ）, a premalignant lesion detected in majority of patients with esophageal adenoearcinoma,is a metaplastic change in the esophageal lining from the usual squamous mucosa to columnar epithelium. BE was classified as short-segment （ 〈 3 cm） or long-segment lesions （ 23 cm） according to the length of metaplastic epithelium on endoscopic examination. The extent of BE on endoscopic exami- nation can also be graded with the use of the Prague circumference and maximum （ C and M） criteria based on the circumferential and maximal extent of the columnar-lined esophagus. To confirm the presence of metaplastic epithelium or neoplastic lesion, mucosal specimens should be obtained by biopsy under endoscopy. In patients with nondysplastic BE, endoscopy should be repeated once every two years, whereas for those who tested negative for dysplasia or early-stage cancer,interval of examinations can be extended to 3 years. In BE patients with severe dysplasia,endoscopic therapies or surgical resection should be considered.