中国实用内科杂志2017，Vol.37Issue(9)：798-809,12.DOI:10.19538/jnk2017090106
中国巴雷特食管及其早期腺癌筛查与诊治共识(2017万宁)
Chinese consensus: screening, diagnosis and management of Barrett's esophagus and adenocarcinoma(2017 Wanning)
摘要
Abstract
There are more and more patients with Barrett's Esophagus (BE) / Columnar lined Esophagus (CLE) and adenocarcinoma,and about 0.61％ BE/CLE will develop to adenocarcinoma.The prognosis of esophageal cancer is related to the stage of tumor when it is diagnosed.Aimed at normalizing the screening,diagnosis and therapy of Barrett's Esophagus (BE) and adenocarcinoma in China,31 professors of digestive diseases,digestive endoscopy and digestive histologists made the consensus on the basis of clinical experience and lots of references.The consensus defines the BE as a complication of gastroesophageal reflux disease (GERD),the normal distal squamous epithelial lining is replaced by columnar epithelial and this must be cleafly visible endoscopically [the squamous-columnar junction (SCJ) is above the gastroesophageal junction (GEJ) ≥ 1 cm] and be confirmed by histology.Adenocarcinoma occurring on BE mucosa is called Barrett's esophageal adenocarcinoma.The early Barrett's esophageal adenocarcinoma is the tumor that localizes in mucosa,and is divided into 4 stages:M1,M2,M3 and M4,according to the tumor infiltration depth.in our country about 90％ esophageal cancers are esophageal squamous cell carcinoma (ESCC),so the consensus recommends that the screening of BE and adenocarcinomas should be emphasized in the screening of ESCC.When diagnosing BE we should have the evidences that it is clearly visible endoscopically that the normal distal squamous epithelial lining is replaced by columnar epithelial (SCJ is above the GEJ ≥ 1 cm),and it is confirmed by histology.The lesion should be further assessedby electron staining endoscopy,such as NBI,FICE and i-scan,and endoscopic ultrasonography (EUS),to help to select the suitable therapy.Endoscopic resection such as ESD and EMR is the preferred therapy,and radiofrequancy ablation (RFA),photodynamic therapy (PDT),Cryotherapy,Argon Plasma Coagulation (APC) should be selected cautiously.The normalized histologic result is very important.We can use it to assess the effect of therapy,whether to perform further treatment and the follow-up.It is recommended that the follow-up should better be done with high resolution endoscope.If it is confirmed that there is no intestinal metaplasia or dysplasia and repeat biopsies in the four quadrants proves BE without intestinal metaplasia or dysplasia and the length ＜ 3 cm,it is recommended to be excluded from the follow-up.BE with intestinal metaplasia and the length ＜3 cm is recommended to be observed every 3-5 years.BE with the length ＞3cm is recommended to be observed every 2-3 years by endoscope.关键词
巴雷特食管/腺癌/共识Key words
Barrett esophagus/adenocarcinoma/consensus分类
医药卫生引用本文复制引用
国家消化系统疾病临床医学研究中心,中华医学会消化内镜学分会,中国医师协会消化医师分会..中国巴雷特食管及其早期腺癌筛查与诊治共识(2017万宁)[J].中国实用内科杂志,2017,37(9):798-809,12.基金项目
国家科技部科技支撑计划(2015BAI13B09) （2015BAI13B09）
北京市科委科技北京百名领军人才培养工程(Z151100000315018) （Z151100000315018）
北京市卫生局(首发)重点攻关计划(首发2014-1-2021) （首发）
北京市科委健康培育项目(Z151100003915097) （Z151100003915097）
