内镜下亚离子凝固术对Barrett’s食管的治疗

Therapy for Barrett's esophagus in endoscope by argon plasma coagulation

目的探讨氩等离子凝固术(APC)治疗Barrett’s食管(BE)后是否复发以及严重程度。方法观察APC治疗后患者食管下段BE黏膜的内镜变化、BE复发率和再治疗率。结果全年内镜检查13 926人中,检出可疑BE患者690例,占就诊人群的1.96%,占接受内镜检查患者的4.95%。接受治疗的患者265例,占可疑BE的38.41%。内镜下组织活检30例,占可疑BE例数的4.35%,全部符合BE病理诊断。术后1个月复发BE例数11例,占总治疗例数的4.15%,术后3月复发BE例数3例,占治疗总例数的1.13%;术后6月复发BE例数2例,占治疗总例数的0.75%;术后1年复发BE例数3例,占总治疗例数的1.13%,内镜下可见明显改变,病变上延最高达食管27 cm处。结论 APC治疗BE后出现柱状上皮肠化生复发率较高,非常有必要持续对这些患者进行观察随访。可疑BE的治疗指征、APC治疗BE的适应证及时机有待进一步研究。

Objective To discuss whether recurrence and severity of argon plasma coagulation （APC） in treatment of Barrett＇ s esophagus （BE）. Methods Patients treated successfully by APC for BE were followed by endoscopic sur- veillance according to a defined protocol. Recurrent or persistent intestinal metaplasia were analyzed. Results Two hun- dred and sixty-five patients were coagulated successfully, and derived from 690 patients with BE by endoscope in 13 926 patients. A total of 150 follow-up endoscopies were performed （follow-up rate： 56.60% ）. The follow-up period was 1 12 months. Recurrent/persistent intestinal metaplasia was detected in 11 patients （RR, recurrence rate： 4.15% ） after 1 month, 3 patients （RR = 1. 13%） after 3 months, 2 patients （RR =0.75%） after 6 months, 3 patients （RR = 1.13% ） after 12 months. Endoscopically visible recurrence in the tubular esophagus was seen in 3 patients. Endoscopic visible lesions flange extended to 27 cm. Conclusion Recurrent/persistent intestinal metaplasia after successful APC of BE is relatively common. This finding has implications for the continued surveillance of patients who were treated suc- cessfully. The indications of treatment for endoscopic suspicious BE and the optimal timing of APC are worthy of further investigation.