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[4] 王拥军[4] 陈光勇[5] 许昌芹[6] 

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]首都医科大学附属北京友谊医院消化内科 [5]首都医科大学附属北京友谊医院病理科 [6]山东大学附属省立医院消化内科

出　　处：《中国医刊》2017年第9期8-19,共12页Chinese Journal of 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：食管癌发病率在我国大陆已居各类肿瘤第3位，死亡率居第4位，越来越受到人们重视。食管癌在组织类型上分为食管鳞状细胞癌（简称食管鳞癌）和食管腺癌。虽然我国食管癌的组织类型以食管鳞癌为主，但是随着世界范围胃食管反流病的增加.Patients with Barrett＇s esophagus （BE）/columnar lined esophagus （CLE） and adenocarcinoma are increasing, in whom 0.61% BE/CLE would develop to adenocarcinoma. The prognosis of esophageal cancer is related to the tumor stage at diagnosis. To standardize the screening, diagnosis and therapy of BE and adenocarcinoma in China, 31 digestive diseases and digestive endoscopy experts and digestive histologists drafted the consensus on the basis of clinical experience and references. The consensus defined BE as a complication of gastroesophageal reflux disease （GERD）. The normal distal squamous epithelial lining is replaced by columnar epithelial. The squamous- columnar junction （SCJ）is above the gastroesophageal junction （GEJ） 〉t lcm and proved by endoscopy and histology. Adenocarcinoma developing in BE mucosa is called Barrett＇s esophageal adenocarcinoma. The early BE carcinoma is divided into 4 stages： M1, M2, M3 and M4, according to the depth of tumor infiltration without expanding beyond mucosa. Because 90% esophageal cancers are esophageal squamous cell carcinoma （ESCC） in China, this consensus emphasizes the significance of screening BE and adenocarcinoma in esophageal cancers. The diagnosis of BE should meet the following criteria： under endoscopy, the normal distal squamous epithelial lining is replaced by columnar epithelial （SCJ is above the GEJ ~〉 lcm）, which is confirmed by histology. The lesion should be further assessed by electron staining endoscopy such as narrow band imaging （NBI）, flexile spectral imaging color enhancement （FICE） and i-scan, and endoscopic ultrasonography （EUS） to choose the optimal therapy. Endoscopic resection such as endoscopic submucosal dissection （ESD） and endoscopic mucosal resection （EMR） is preferred. Radiofrequancy ablation （RFA）, photodynamic therapy （PDT）, cryotherapy, Argon plasma coagulation （APC） are alternative therapeutic regimens yet should be administrated cautiously. The standardized histologic r

关 键 词：巴雷特食管 癌筛查 食管鳞状细胞癌 诊治 早期 中国 胃食管反流病 食管鳞癌 

分 类 号：R735.1[医药卫生—肿瘤]