食管上段胃黏膜异位内镜下合并症的研究

Study on complications of upper esophageal gastric mucosa under heterotopic endoscopy

目的研究食管上段胃黏膜异位(HGMUE)的内镜检出率、内镜下表现和合并症。方法回顾性研究2019年1月-2020年6月该院消化内镜中心经电子食管胃镜检查且诊断为HGMUE的患者资料。分析HGMUE的检出率、内镜下表现和合并症。结果 51 326例接受胃镜检查的患者中,375例诊断为HGMUE,检出率为0.73%。内镜下主要表现为玫瑰色-橘红色的天鹅绒样斑块,与周围食管黏膜界限清楚,可有多个,且大小不一。内镜下合并症包括:内镜阳性的胃食管反流病75例(20.00%),其中反流性食管炎44例(11.73%)、Barrett食管26例(6.93%)、两者合并存在5例(1.13%);糜烂性胃炎56例(14.93%);息肉54例(14.40%),其中胃息肉47例(12.53%)、十二指肠球部息肉7例(1.87%);消化性溃疡42例(11.20%),其中十二指肠球部溃疡21例(5.60%)、胃溃疡17例(4.53%)、两者合并存在4例(1.07%);恶性肿瘤9例(2.40%),其中胃癌3例(0.80%)、食管癌6例(1.60%),无合并症的HGMUE 139例(37.06%)。结论HGMUE合并酸相关性疾病较为常见;合并上消化道恶性肿瘤尤其是食管恶性肿瘤的占比较高,这可能是上消化道肿瘤的预警因子之一,应予以重视。

Objective To investigate the incidence of heterotopic gastric mucosa in upper esophagus(HGMUE),and study the endoscopic manifestation and comorbidity of HGMUE.Methods A retrospective study was made among patients who underwent esophago-gastroduo-denoscopy and diagnosed with HGMUE from January 2019 to June 2020.Results Of the 51326 patients who underwent EGD,375 were diagnosed with HGMUE(0.73%).HGMUE are a velvety mucosa that is rosiness-orange in color,well-circumscribed in area,variable in quantity and size.Endoscopic complications include:gastroesophageal reflux disease with positive endoscopic image(n=75,20.00%)which included reflux esophagitis(RE,n=44,11.73%),Barrett’s esophagus(BE,n=26,6.93%),RE and BE coexists(n=5,1.13%);Erosive gastritis(n=56,14.93%);Polyps(n=54,14.40%)which included gastric polyps(n=47,12.53%)and duodenal polyps(n=7,1.87%).The forth was peptic ulcer(n=42,11.20%)which included duodenal ulcer(DU,n=21,5.60%),gastric ulcer(GU,n=17,4.53%),GU and DU coexists(n=4,1.07%);Malignancy(n=9,2.40%)which included gastric carcinoma(n=3,0.80%)and esophageal carcinoma(n=6,1.60%).HGMUE without endoscopic complications(n=139,37.06%).Conclusion Acid related diseases were common comorbidities of HGMUE.Since a relatively high prevalence of malignancy,especially esophageal malignancy was found as comorbidity of HGMUE,it could be a warning factor for malignancy.