Chapter 2: Role of pathologic confirmation for Barrett′s esophagus and dysplasia

Techniques in Gastrointestinal Endoscopy Pub Date : 2018-04-01 DOI:10.1016/j.tgie.2018.03.002

Esther Klaver MD , Myrtle J. van der Wel MD , Sybren L. Meijer MD, PhD , Jacques J.G.H.M. Bergman MD, PhD , Roos E. Pouw MD, PhD

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Abstract

Barrett′s esophagus (BE) is a premalignant condition defined by the replacement of squamous epithelium by columnar epithelium in the distal part of the esophagus. Patients with BE have an increased risk of progression to esophageal adenocarcinoma (EAC). Advanced EAC has a poor 5-year survival rate. However, if EAC is diagnosed at an early stage, endoscopic treatment has proven to be a safe and effective treatment, with excellent long-term survival rates. Currently it is not possible to accurately predict which patients with BE will develop EAC. Despite promising developments in genetic and molecular biomarker research, grade of dysplasia is still the best predictor for progression to EAC. Present guidelines advise surveillance endoscopies with biopsies for BE patients to detect early neoplasia at a treatable stage. Surveillance intervals are determined by length of the BE segment and on the histopathologic diagnosis of the biopsies. Accurate histopathologic assessment of biopsies to define surveillance intervals or to decide on a treatment strategy, is therefore of the utmost importance.

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第二章:Barrett食管及发育不良的病理证实

巴雷特食管(BE)是一种癌前病变，定义为食管远端鳞状上皮被柱状上皮取代。BE患者进展为食管腺癌(EAC)的风险增加。晚期EAC的5年生存率很低。然而，如果早期诊断出EAC，内镜治疗已被证明是一种安全有效的治疗方法，具有良好的长期生存率。目前还不可能准确预测哪些BE患者会发展为EAC。尽管遗传和分子生物标志物研究取得了可喜的进展，但发育不良的等级仍然是进展为EAC的最佳预测指标。目前的指南建议对BE患者进行监测内窥镜和活检，以在可治疗阶段发现早期肿瘤。监测间隔由BE段的长度和活检的组织病理学诊断决定。因此，对活检进行准确的组织病理学评估，以确定监测间隔或决定治疗策略，是至关重要的。

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Techniques in Gastrointestinal Endoscopy GASTROENTEROLOGY & HEPATOLOGY-

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期刊介绍： The purpose of each issue of Techniques in Gastrointestinal Endoscopy is to provide a comprehensive, current overview of a clinical condition or surgical procedure in gastrointestinal endoscopy, combining the effectiveness of an atlas with the timeliness of a journal. Each issue places a vigorous emphasis on diagnosis, rationale for and against a procedure, actual technique, management, and prevention of complications. The journal features abundant illustrations, line drawings and color artwork to guide readers through even the most complicated procedure.

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