Regression of Barrett＇s Esophagus： Is There a Difference between Clinical and Surgical Treatment？

Objective： To evaluate the response to clinical and surgical treatment of Walter Cantidio University Hospital patients who were diagnosed with Barrett＇s esophagus between 2012 and 2016. Methodology： From the database analysis of Walter Cantidio University Hospital＇s pathology service, we identified all patients with a diagnosis of Barrett＇s esophagus between 2012 and 2016. We analyzed the patients＇ medical records and collected epidemiological and clinical data. Results： 22 patients were included in the study, 13 of whom were surgically treated and 9 were clinically treated. The regression was 33.3% in the clinical group and 30.7% in the surgical group, with no statistical difference between these two groups. Conclusions： The results show synchrony with data from the medical literature regarding the response of Barrett＇s esophagus to clinical and surgical treatment.

脱氧胆酸通过ROS/NF-κB通路对Barrett食管细胞氧化应激的影响

目的 探讨脱氧胆酸(DCA)对人BAR-T细胞氧化应激的影响及机制。方法 体外培养人Barrett上皮细胞株BAR-T,采用不同浓度的DCA(100、200、300μmol/L)和不同作用时间(30 min、60 min、3 h、6 h)干预BAR-T细胞。采用Real-time PCR法和Western blotting法检测环氧酶-2(COX-2)的mRNA和蛋白表达;采用显微镜观察和流式细胞仪检测细胞内活性氧(reactive oxygen species, ROS)含量,并与200μmol/L DCA+5 mmol/L ROS清除剂N-乙酰半胱胺酸(NAC)组进行比较;采用细胞免疫荧光法检测细胞p65蛋白入核情况,并与200μmol/L DCA+100μmol/L NF-κB通路抑制剂吡咯烷二硫代甲酸铵(PDTC)组进行比较。结果 与对照组相比,DCA可以显著升高BAR-T细胞中ROS的含量,呈剂量依赖性,5 mmol/L NAC明显抑制DCA诱导的ROS释放。与对照组相比,相同干预时间下,DCA(200、300μmol/L组)均可以显著升高COX-2 mRNA表达。与1 h组相比,200、300μmol/L DCA 6 h组均可以显著升高COX-2 mRNA表达。与对照组比较,200μmol/L DCA可以显著升高COX-2蛋白表达。同时,200μmol/L DCA可以促进p65蛋白的入核,PDTC可以抑制DCA的作用。结论 DCA可能通过升高细胞内ROS水平,促进p65蛋白入核以激活NF-κB信号通路,进而上调COX-2的表达。

Socioeconomic traits and the risk of Barrett’s esophagus and gastroesophageal reflux disease: A Mendelian randomization study

BACKGROUND Previous observational studies have shown that the prevalence of gastroesophageal reflux disease(GERD)and Barrett’s esophagus(BE)is associated with socioeconomic status.However,due to the methodological limitations of traditional observational studies,it is challenging to definitively establish causality.AIM To explore the causal relationship between the prevalence of these conditions and socioeconomic status using Mendelian randomization(MR).METHODS We initially screened single nucleotide polymorphisms(SNPs)to serve as proxies for eight socioeconomic status phenotypes for univariate MR analysis.The inverse variance weighted(IVW)method was used as the primary analytical method to estimate the causal relationship between the eight socioeconomic status phenotypes and the risk of GERD and BE.We then collected combinations of SNPs as composite proxies for the eight socioeconomic phenotypes to perform multivariate MR(MVMR)analyses based on the IVW MVMR model.Furthermore,a two-step MR mediation analysis was used to examine the potential mediation of the associations by body mass index,major depressive disorder(MDD),smoking,alcohol consumption,and sleep duration.RESULTS The study identified three socioeconomic statuses that had a significant impact on GERD.These included household income[odds ratio(OR):0.46;95% confidence interval(95%CI):0.31-0.70],education attainment(OR:0.23;95%CI:0.18-0.29),and the Townsend Deprivation Index at recruitment(OR:1.57;95%CI:1.04-2.37).These factors were found to independently and predominantly influence the genetic causal effect of GERD.Furthermore,the mediating effect of educational attainment on GERD was found to be mediated by MDD(proportion mediated:10.83%).Similarly,the effect of educational attainment on BE was mediated by MDD(proportion mediated:10.58%)and the number of cigarettes smoked per day(proportion mediated:3.50%).Additionally,the mediating effect of household income on GERD was observed to be mediated by sleep duration(proportion mediated:9.75%)CONCLUSION This MR study shed light on the link between socioeconomic status and GERD or BE,providing insights for the prevention of esophageal cancer and precancerous lesions.

Hybrid argon plasma coagulation for the treatment of Barrett’s esophagus:A prospective,multicenter study

BACKGROUND The incidence of Barrett’s esophagus(BE)in China is lower compared to the Western populations.Hence,studies conducted in the Chinese population has been limited.The current treatment options available for BE treatment includes argon plasma coagulation(APC),radiofrequency ablation and cryoablation,all with varying degrees of success.AIM To determine the efficacy and safety of HybridAPC in the treatment of BE.METHODS The study cohort consisted of patients with BE who underwent HybridAPC ablation treatment.These procedures were performed by seven endoscopists from different tertiary hospitals.The duration of the procedure,curative rate,complications and recurrent rate by 1-year follow-up were recorded.RESULTS Eighty individuals were enrolled for treatment from July 2017 to June 2020,comprising of 39 males and 41 females with a median age of 54 years(range,30 to 83 years).The technical success rate of HybridAPC was 100%and the overall curative rate was 98.15%.No severe complications occurred during the operation.BE cases were classified as short-segment BE and long-segment BE.Patients with short-segment BE were all considered cured without complications.Thirty-six patients completed the one-year follow-up without recurrence.Twenty-four percent had mild dysplasia which were all resolved with one post-procedural treatment.The mean duration of the procedure was 10.94±6.52 min.CONCLUSION Treatment of BE with HybridAPC was found to be a simple and quick procedure that is safe and effective during the short-term follow-up,especially in cases of short-segment BE.This technique could be considered as a feasible alternative ablation therapy for BE.

肠上皮化生在Barrett’s食管进展为食管腺癌中作用的研究进展

食管腺癌(esophageal adenocarcinoma,EAC)的发病率有逐年增加的趋势,EAC预后差,5年生存率不足20%.Barrett’s食管(barrett’sesophagus,BE)是目前唯一已知的EAC癌前病变,伴肠上皮化生(intestinal metaplasia,IM)的BE有更高的风险进展为EAC,探究IM的发生机制,寻找BE的针对性治疗靶点,成为预防肿瘤的重要措施.胆汁酸反流被认为是IM发生的重要因素,并促进BE向EAC进展,但胆汁反流诱导肠化、癌变的分子调节机制尚不清楚.本文就IM发生的环境、意义、细胞起源学说,胆汁反流的毒性作用以及IM向肿瘤进展的分子改变进行综述,旨在提高临床医师对BE中IM的认识,为早期干预BE和防治EAC提供证据.

角膜横径和晶状体厚度在Barrett UniversalⅡ人工晶状体计算公式中的应用价值

目的:探讨运用Barrett UniversalⅡ公式(BUⅡ公式)计算人工晶状体(intraocular lens,IOL)屈光力时,可选参数角膜横径,又称白到白(white-to-white,WTW)与晶状体厚度(lens thickness,LT)的实际应用价值。方法:采用单中心、前瞻性临床研究,连续纳入同一术者顺利进行白内障超声乳化吸除术联合MX60(IOL植入术患眼279眼,术前使用OA-2000非接触式光学生物测量仪测量眼部数据并计算IOL植入度数,代入BUⅡ公式保留或去掉可选参数WTW、LT计算预测结果,进一步根据患者眼轴长度(axial length,AL)分亚组分析。主要结局指标:随访患者至术后1个月以上,比较使用和未使用WTW和LT两个参数、BUⅡ公式预测误差(prediction error,PE)、绝对预测误差(absolute error,AE)、AE小于0.5 D所占比例。结果:总体1上,忽略WTW+LT,PE为-0.05 D(-0.26,0.18)(P=0.011),其他参数组合的PE与0比较差异无统计学意义(P>0.05)。各参数组合的AE比较差异无统计学意义(0.22~0.23 D,P=0.404)。同时忽略WTW+LT时AE出现最大值(+1.5 D)。应用WTW+LT、忽略WTW+LT、忽略WTW和忽略LT时纳入患者AE≤0.50 D的比例分别为80.65%、79.57%、80.65%和81.36%。在各眼轴亚组中,忽略LT时,AE≤0.50 D的百分比在短眼轴亚组(80.00%vs.66.67%~73.33%)与长眼轴亚组(77.78%vs.73.33%~75.56%)中较高。在中等眼轴亚组中,AE≤0.50 D百分比代入全部参数时略高(83.11%vs.80.82%~82.19%),忽略WTW+LT计算时稍低(80.82%)。结论:使用BUⅡ计算IOL屈光力时,可选参数WTW和LT无论是否代入公式中,皆可得到相近的平均预测水平;但是,同时忽略WTW和LT可能出现较大预测误差。对于22mm≤AL<26mm眼,推荐代入全部参数计算;当AL≤22mm或AL≥26mm,仅输入WTW的计算方法累积精确度更高,可优先采用。

Artificial intelligence system for the detection of Barrett’s esophagus

BACKGROUND Barrett’s esophagus(BE),which has increased in prevalence worldwide,is a precursor for esophageal adenocarcinoma.Although there is a gap in the detection rates between endoscopic BE and histological BE in current research,we trained our artificial intelligence(AI)system with images of endoscopic BE and tested the system with images of histological BE.AIM To assess whether an AI system can aid in the detection of BE in our setting.METHODS Endoscopic narrow-band imaging(NBI)was collected from Chung Shan Medical University Hospital and Changhua Christian Hospital,resulting in 724 cases,with 86 patients having pathological results.Three senior endoscopists,who were instructing physicians of the Digestive Endoscopy Society of Taiwan,independently annotated the images in the development set to determine whether each image was classified as an endoscopic BE.The test set consisted of 160 endoscopic images of 86 cases with histological results.RESULTS Six pre-trained models were compared,and EfficientNetV2B2(accuracy[ACC]:0.8)was selected as the backbone architecture for further evaluation due to better ACC results.In the final test,the AI system correctly identified 66 of 70 cases of BE and 85 of 90 cases without BE,resulting in an ACC of 94.37%.CONCLUSION Our AI system,which was trained by NBI of endoscopic BE,can adequately predict endoscopic images of histological BE.The ACC,sensitivity,and specificity are 94.37%,94.29%,and 94.44%,respectively.

魏睦新教授基于辛开苦降论治Barrett食管经验

Barrett食管(BE)是食管腺癌前期病变,其病程迁延难愈,临床表现复杂多样且不典型。魏睦新教授认为,BE病位在食管,属胃所主,与肝、脾关系密切,并以辛开苦降为法,佐以理气、化痰、消瘀治标,以半夏泻心汤合左金丸化裁,自创辛开苦降散结方治疗,临床取得良好疗效。

化痰健脾理气方联合埃索美拉唑治疗Barrett食管观察

本文探讨化痰健脾理气方联合埃索美拉唑治疗Barrett食管的疗效及对细胞因子的影响,旨在为Barrett食管用药提供参考。1资料与方法1.1一般资料:选择2019年6月~2021年6月我院94例Barrett食管患者,依据随机数字表法分为观察组47例与对照组47例。观察组病程8个月~9年,平均(5.03±1.38)年;年龄39~73岁,平均(58.92±6.47)岁;女性21例,男性26例。

Graft dilatation and Barrett’s esophagus in adults after gastric pullup and jejunal interposition for long-gap esophageal atresia

BACKGROUND Esophageal replacement(ER)with gastric pull-up(GPU)or jejunal interposition(JI)used to be the standard treatment for long-gap esophageal atresia(LGEA).Changes of the ER grafts on a macro-and microscopic level however,are unknown.AIM To evaluate long-term clinical symptoms and anatomical and mucosal changes in adolescents and adults after ER for LGEA.METHODS A cohort study was conducted including all LGEA patients≥16 years who had undergone GPU or JI between 1985-2003 at two tertiary referral centers in the Netherlands.Patients underwent clinical assessment,contrast study and endoscopy with biopsy.Data was collected prospectively.Group differences between JI and GPU patients,and associations between different outcome measures were assessed using the Fisher’s exact test for bivariate variables and the Mann-Whitney U-test for continuous variables.Differences with a P-value<0.05 were considered statistically significant.RESULTS Nine GPU patients and eleven JI patients were included.Median age at follow-up was 21.5 years and 24.4 years,respectively.Reflux was reported in six GPU patients(67%)vs four JI patients(36%)(P=0.37).Dysphagia symptoms were reported in 64%of JI patients,compared to 22%of GPU patients(P=0.09).Contrast studies showed dilatation of the jejunal graft in six patients(55%)and graft lengthening in four of these six patients.Endoscopy revealed columnar-lined esophagus in three GPU patients(33%)and intestinal metaplasia was histologically confirmed in two patients(22%).No association was found between reflux symptoms and macroscopic anomalies or intestinal metaplasia.Three GPU patients(33%)experienced severe feeding problems vs none in the JI group.The median body mass index of JI patients was 20.9 kg/m^(2) vs 19.5 kg/m^(2) in GPU patients(P=0.08).CONCLUSION The majority of GPU patients had reflux and intestinal metaplasia in 22%.The majority of JI patients had dysphagia and a dilated graft.Follow-up after ER for LGEA is essential.

Role of artificial intelligence in Barrett’s esophagus

The application of artificial intelligence(AI)in gastrointestinal endoscopy has gained significant traction over the last decade.One of the more recent applications of AI in this field includes the detection of dysplasia and cancer in Barrett’s esophagus(BE).AI using deep learning methods has shown promise as an adjunct to the endoscopist in detecting dysplasia and cancer.Apart from visual detection and diagnosis,AI may also aid in reducing the considerable interobserver variability in identifying and distinguishing dysplasia on whole slide images from digitized BE histology slides.This review aims to provide a comprehensive summary of the key studies thus far as well as providing an insight into the future role of AI in Barrett’s esophagus.

Optical molecular imaging for detection of Barrett's-associated neoplasia

Recent advancements in the endoscopic imaging of Barrett's esophagus can be used to probe a wide range of optical properties that are altered with neoplastic progression.This review summarizes relevant changes in optical properties as well as imaging approaches that measures those changes.Wide-field imaging approaches include narrow-band imaging that measures changes in light scattering and absorption,and autofluorescence imaging that measure changes in endogenous fluorophores.High-resolution imaging approaches include optical coherence tomography,endocytoscopy,confocal microendoscopy,and high-resolution microendoscopy.These technologies,some coupled with an appropriate contrast agent,can measure differences in glandular morphology,nuclear morphology,or vascular alterations associated with neoplasia.Advances in targeted contrast agents are further discussed.Studies that have explored these technologies are highlighted;as are the advantages and limitations of each.

Prevalence of Barrett's esophagus in patients with moderate to severe erosive esophagitis

AIM: To investigate the proportion of patients with moderate-severe erosive esophagitis (EE) who will have Barrett's esophagus (BE) after healing of inflammation. METHODS: Patients with EE of Los Angeles (LA) class B, C and D who underwent follow-up endoscopy documenting complete mucosal healing. RESULTS: A total of 86/169 patients were suspected of having BE (38 before healing and 48 after healing of EE) and, 46/86 eventually had the histological confirmation. At index esophago-gastro-duodenoscopy (EGD), BE was suspected in 38/169 (22%), and ultimately, histologically confirmed in 20 of these. In 11 patients where biopsies were performed in the presence of inflammation, BE was detected in 2 and missed in 5 (including 2 dysplasias). In 131/169 patients (77.5%), BE was not suspected at index EGD. After healing of EE though, 48 patients had suspicion of BE who underwent biopsies, and in 26 of these histology was positive for BE. The length of inflammation had a linear correlation with the length of BE (P = 0.01). Out of multiple variables to predict BE, only the suspicion at index endoscopy was statistically significant (P = 0.01). CONCLUSION: BE was seen in 46/169 (27%) patients with EE of LA class B, C and D. The length of EE can predict the length of underlying BE segment.Even when suspected, BE and associated dysplasia can be missed in the presence of inflammation; therefore, repeat evaluation should be considered after complete healing of esophagitis.

内镜窄带成像技术对Barrett食管合并早期食管腺癌的诊断价值

目的探讨内镜窄带成像技术(NBI)对Barrett食管(BE)患者早期食管腺癌的诊断价值。方法选取176例内镜诊断为BE的患者,分别在常规白光摸式、NBl模式及1.2%碘溶液染色模式下观察,对所有可疑病变部位均取活检,所有病变均以病理结果作为诊断标准,分别与病理诊断结果对比。结果 176例患者,病理诊断BE的160例,其中3例被诊断为早期食管腺癌(EAC),将3种方法的结果相比,对敏感度、特异度、准确度、阳性预测值、阴性预测值、阳性似然比和阴性似然比进行比较。NBI和复方碘溶液的敏感性和阴性预测值均为100%,两者的特异性分别为89.8%和91.7%,均优于常规白光内镜。结论 NBI技术对BE合并早期食管腺癌具有高灵敏度和高阴性预测值,它的结果与复方碘溶液染色所获得的结果具有可比性。

高清染色内镜对Barrett食管的诊断价值

目的探讨高清染色(EPK-i)内镜对Barrett食管的诊断价值。方法统计我院消化内镜中心用EPK-i内镜检查的1 806例患者和普通内镜检查的1 784患者中诊断为Barrett食管的病例,比较Barrett食管的检出率、病理符合率,评价不同内镜图像的清晰度、黏膜下血管特征。结果 EPK-i内镜的Barrett食管镜下检出率、病理符合率高于普通内镜,差异具有统计学意义(P<0.05)。EPK-i内镜检查病变边界轮廓、黏膜血管清晰度优于普通胃镜(P<0.01)。EPK-i内镜观察病变栅栏状血管网43例(72.9%),普通胃镜模式下观察到19例(48.7%),两者比较差异有统计学意义(P<0.01)。结论 EPK-i内镜在Barrett食管的诊断中,镜下检出率及病理符合率均高于普通内镜,显著提高Barrett食管的诊断率。

糜烂性食管炎、Barrett食管及食管腺癌中SOX2、CDX2的表达及其临床意义

目的探讨CDX2、SOX2在糜烂性食管炎、Barrett食管的3种不同组织类型(胃底型、贲门型、肠化生型)及食管腺癌(esophageal adenocarcinoma,EAC)中的表达及意义。方法采用免疫组化Eli Vision两步法检测CDX2和SOX2在35例贲门组、23例胃底组、14例肠化组、10例糜烂性食管炎组、7例EAC组、10例正常食管下段黏膜中的表达情况。结果 CDX2在肠化组及EAC组中的阳性率均为85.7%,显著高于其他四组(P<0.05);CDX2阳性率在贲门组(11.4%)、胃底组(0)、糜烂性食管炎组(0)及正常食管组(0)中的差异无显著性(P>0.05)。CDX2在贲门组(75%)及EAC组(66.7%)以(+)为主,差异无统计学意义(P>0.05),与肠化组(91.7%)以()为主显著不同(P<0.05)。SOX2在Barrett食管三组中的阳性率均为100%,显著高于EAC组(28.6%)(P<0.05)。SOX2以(++)表达方式在胃底组(95.7%)及贲门组(74.3%)中差异无统计学意义(P>0.05);显著高于肠化组(50%)和EAC组(50%)(P<0.05)。SOX2和CDX2的表达在肠化型Barrett食管中呈负相关(P<0.05),在贲门组、胃底组、EAC组中无明显相关(P>0.05)。结论短段贲门型Barrett食管中CDX2的阳性率不高,可能只是一种柱状上皮化生,与EAC的关系不大;CDX2在鳞状上皮向特殊肠上皮化生转化过程中发挥重要作用,SOX2的沉默促进EAC发生。

Cdx2 LI-CD和p63在Barrett食管中的表达及相互关系

目的:探讨Cdx2、LI-CD和p63在Barrett食管中的表达及相互关系。方法:随机选取胃镜下食管黏膜10例、食管炎组织标本20例和Barrett食管组织标本22例。进行Cdx2、LI-CD和p63免疫组化染色,对不同组织中上述指标的表达情况以及Barrett食管中Cdx2与LI-CD的相关性进行分析。结果:Cdx2、LJ-CD在正常食管黏膜和食管炎组织中均无表达,在Barrett食管中表达阳性率分别为86.4%(19/22)和77.3%(17/22),并且二者在Barrett食管中的表达具有显著正相关性(r=0.750,P<0.01)。p63在肠化生组织中没有表达。在部分柱状上皮化生的组织中,有少量p63蛋白表达。结论:Cdx2和LI-CD蛋白在Barrett食管组织中异位表达,可作为Barrett食管的早期标志;在Bar-rett食管中二者表达具有相关性。p63在Barrett食管中下调表达。p63和Cdx2等基因可能参与了Barrett食管的发生。

Barrett食管诊治共识(修订版2011年6月重庆)

为规范我国Barrett食管（BE）的诊断和治疗,中华医学会消化病学分会于2011年6月4日在重庆召开了＂全国第二届Barrett食管专题学术研讨会＂,就BE有关问题进行了广泛的讨论,并对2005年制定的＂Barrett食管诊治共识（草案）＂作了修订和补充,达成以下共识。

中国人Barrett食管临床特点分析

目的 研究中国人Barrett食管（Barrett’s esophagus，BE）的临床特点。方法以“Barrett食管”为检索词，电脑检索1989年～2007年国内公开发表的中文文献，以“Barrett esophagus”和“China”为检索词，电脑在MEDLINE上检索1989年-2007年公开发表有关中国Barrett食管临床研究英文文献，统一纳入标准和排除标准，所得资料进行荟萃分析。结果共41项研究中的4132例BE患者进入本研究：①BE的内镜检出率为2．39％，男女比为2．08：1，平均发病年龄为53．27岁，有典型胃食管反流病（GERD）症状的51．00％；②内镜下形状以岛状居多，为56．81％；特殊肠化生型为36．58％；舌型BE的特殊肠化生检出率较全周型、岛状均显著增高（均P〈0．001）；长段Barrett食管的特殊肠化生型检出率高于短段Barrett食管（P〈0．001）；③492例BE患者平均2年随访，癌变发生率为0．61％。结论我国人内镜BE检出率低于西方人，平均发病年龄低于西方国家报道，癌变发生率与国外报道接近，男性多发、临床症状、特殊肠化生型检出率等与国外报道一致。