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)

作　　者：无 李鹏 王拥军 陈光勇 许昌芹[4] 

机构地区：[1]国家消化系统疾病临床医学研究中心 [2]中华医学会消化内镜学分会 [3]中国医师协会消化医师分会 [4]山东大学附属省立医院消化内科 [5]不详

出　　处：《中国实用内科杂志》2017年第9期798-809,共12页Chinese Journal of Practical Internal Medicine

基　　金：国家科技部科技支撑计划(2015BAI13B09);北京市科委科技北京百名领军人才培养工程(Z151100000315018);北京市科委健康培育项目(Z151100003915097);北京市卫生局(首发)重点攻关计划(首发2014-1-2021)

摘　　要：中国巴雷特食管(Barrett’s Esophagus,BE)、食管下段柱状上皮化生(Columnar Lined Esophagus,CLE)和食管腺癌的发病率在逐渐增加,巴雷特食管的癌变率约0.61%。食管癌病人的预后与诊断时肿瘤的分期密切相关,中国31位消化病学及消化内镜学专家在查阅相关文献及临床经验的基础上共同制订了中国的巴雷特食管及其早期腺癌筛查与诊治共识,旨在规范国内对巴雷特食管及其早期腺癌的筛查诊断及治疗,提高国人的健康水平。本共识定义巴雷特食管为胃食管反流病的并发症,内镜下可见食管鳞柱交界相对于胃食管结合部上移≥1 cm,并病理证实有覆层鳞状上皮被柱状上皮取代。而发生于巴雷特食管黏膜的腺癌称为巴雷特食管腺癌,局限于黏膜层者为早期巴雷特食管腺癌,并根据肿瘤浸润深度将其分为M1、M2、M3及M4期。因为中国食管癌以鳞癌为主,占90%以上,所以本共识主张在进行食管鳞癌筛查的同时注重巴雷特食管及其腺癌的筛查。对于巴雷特食管及其腺癌的诊断应内镜结合病理,并且应用窄带成像技术、内镜智能分光比色技术、高清智能电子染色内镜等电子染色内镜以及超声内镜等技术来综合客观地评估病变,指导制定治疗方案的选择。巴雷特食管及其早期腺癌的治疗应以内镜下病变切除术为主,包括内镜下黏膜剥离术和内镜下黏膜切除术,应慎重选择内镜下病变毁损治疗(内镜下射频消融术、光动力疗法、冰冻疗法、氩离子束凝固术)。术后应通过规范化的病理结果来评估治疗,判定是否需要进一步的追加治疗以及制定随访方案。建议用高分辨率内镜监测;对于BE<3 cm,不伴有肠上皮化生或异型增生(上皮内瘤变)者,经重复4个象限内镜下黏膜活检证实没有肠上皮化生,建议退出监测;BE<3 cm伴有肠上皮化生者,建议每3~5年行1次内镜检查;对于≥3 cm BE患者,建议每2~3年行1次内�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 clearly 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 dearly visible endoscopicaUy 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 therap）5 and radiofrequancy ablation （RFA）, photodynamic therapy （PDT）, Cryotherapy, Argon Plasma Coagulation （APC） should be selected cautiously. The normalize

关 键 词：巴雷特食管 腺癌 共识 

分 类 号：R735.1[医药卫生—肿瘤]