根据选择性管理算法,针对低级失塑性巴雷特病的监测或内镜治疗的长期结果
Tony He1,2, Mark Lai1, Kiran G Iyer1
1Gastroenterology, St Vincent's Hospital Melbourne Pty Ltd., Fitzroy, Australia.
Endoscopy international open
|March 4, 2026
概括
选择性治疗低度发育不良巴雷特病 (LGD) 是安全的. 低风险的LGD患者可以进行监测,而高风险的患者可以从内镜消除疗法 (EET) 中受益,以减少进展风险.
科学领域:
- 胃肠病学 胃肠病学
- 在瘤学瘤学.
- 内镜检查是指内镜检查.
背景情况:
- 对于管理低级失塑性巴雷特食道 (LGD) 存在相互矛盾的指导方针.
- 目前的建议在欧洲和美国的指导方针之间有关监测与内镜治疗的不同.
- 需要评估LGD的选择性管理算法.
研究的目的:
- 评估LGD选择性管理算法的性能.
- 根据选择性管理方法,为LGD患者提供现实世界的结果.
- 为了确定不同管理策略下的LGD的进展率.
主要方法:
- 从2008年至2022年期间,从497名患有失塑性巴雷特病的患者收集前性数据.
- 经由胃肠病理学专家证实的LGD定义.
- 基于风险分层的选择性管理:持久性/多聚焦性LGD接受了内镜根除疗法 (EET),非持久性单聚焦性LGD接受了监测.
主要成果:
- 135名患者患有LGD;22名低风险 (LR-S) 被监测,8名高风险 (HR-S) 被监测,105名高风险 (HR-EET) 接受了EET.
- 在LR-S (4.5%) 和HR-EET (6.7%) 队列中,进展率相似 (P=0.43).
- HR-S组的进展明显较高 (25%,P=0.04). 反流性食道炎与高风险LGD (SHR 3.21,P=0.04) 的进展相关.
结论:
- 对LGD的选择性管理算法是安全有效的.
- 对于被确定为低风险LGD的患者,监测是适当的.
- 高风险的LGD患者,特别是患有逆流食道炎的患者,可能需要EET和优化的酸抑制疗法以减轻进展风险.
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