内镜下氩离子凝固术、射频联合抑酸治疗Barrett食管上皮的临床观察

目的观察内镜下氩离子凝固术（APC）、射频治疗术（RF）联合奥美拉唑治疗Barrett食管（BE）上皮的临床效果。方法选择经胃镜和病理证实的BE患者23例,分别行APC或RF,并于术后给予抗反流和抑酸剂治疗。分别于术后1个月、治疗结束后第3、6、12个月进行复查,评价其疗效和不良反应。结果所有患者均完成治疗,采用APC治疗的15例患者中有12例首次治疗即全部清除病灶,另外3例经2次治疗病灶亦完全清除;采用射频治疗的8例患者中有3例治疗1次病灶即消失,4例经2次、1例经3次治疗后始见BE完全消除。12个月后复查5例患者复发。结论应用APC、射频联合抑酸剂治疗BE方法简便易行、安全,且APC治疗效果优于RF。     

内镜下氩离子凝固术治疗消化道病变的临床研究

目的探讨氩离子凝固术（APC）在消化道病变介入治疗中应用。方法采用内镜下APC治疗120例消化道病变患者,并观察其治疗效果。结果100例胃肠道广基、扁平息肉经APC治疗后3个月复查内镜,黏膜色泽正常,原治疗部位无复发;10例疣状胃炎患者治疗后3个月内镜复查病灶好转或消失,2例Barrett食管患者3个月内镜及病理检查示恢复为鳞状上皮,5例放射性肠炎出血经APC治疗后均无明显出血,3例食管支架植入后再狭窄晚期食管癌患者经APC治疗后实现再通。结论APC在消化道病变内镜介入治疗中效果显著,且简便易行,并发症少,有较高的临床应用价值。     

氩离子凝固术治疗成熟型疣状胃炎38例观察

目的探讨氩离子凝固术对疣状胃炎的治疗效果。方法在内镜直视下,采用氩离子凝固器,经内镜钳道插入氩气电凝导管,直至病灶上方0.3～0.5cm处,以每次1～3s的时间对疣状胃炎进行氩离子凝固术治疗。结果38例疣状胃炎患者临床症状明显改善,内镜复查病灶消失。结论氩离子凝固术治疗疣状胃炎是一种疗效确切、易于掌握、安全有效的方法。     

氩离子凝固术加抑酸治疗Barrett食管36例的护理配合

目的：探讨氩离子凝固术（APC）及抑酸治疗Barrett食管（BE）36例术前、术后护理配合的方法，并评价其疗效。方法：选择经胃镜和病理组织学证实的BE患者36例，行APC治疗术前正确评估患者心身状态，适时给予心理疏导，介绍相关注意事项。并于术后给予抗反流及抑酸治疗，严防并发症的发生。分别于术后1个月、6个月、1a进行复查，观察其疗效。结果：术后1个月复查，22例病灶完全消失，14例进行第二次治疗后，病灶消失，经0．5a及1a后复查有10例复发。未发现癌变，无出血、穿孔等并发症。结论：应用APC治疗BE，方法简便易行，安全、有效。良好的护理配合是其重要保障。     

内镜下氩离子凝固术治疗Barrett食管118例临床分析

目的:探讨内镜下氩离子凝固术治疗Barrett食管的疗效。方法:经胃镜检查、病理证实的Barrett食管患者118例,在内镜下行氩离子凝固术治疗,术后给予质子泵抑制剂辅助治疗,于治疗后3,6,12个月进行复查,并对其疗效及并发症进行评估。结果:患者均完成治疗,92例首次治疗即全部清除病灶,余26例经2次治疗病灶完全清除。术后1年复查10例复发,复发率8.47%。术后17例(14.4%)出现胸骨后不适症状,9例(7.0%)出现胸骨后疼痛,给予质子泵抑制剂后缓解,3～7d症状消失;4例(3.1%)出现食管黏膜下气肿,自行吸收。结论:内镜下氩离子凝固术治疗Barrett食管安全、有效。     

内镜下氩离子凝固术治疗隆起糜烂性胃炎疗效分析

目的：探讨内镜下氩离子凝固术（APC）对隆起糜烂性胃炎的治疗价值。方法：对68例隆起糜烂性胃炎患者进行内镜下氩离子凝固术治疗。对照组60例患者予雷贝拉唑、瑞巴派特药物治疗。结果：APC治疗2周后，患者临床症状改善，治疗4周后复查胃镜发现，原病灶已消失。与对照组相比，差异有显著性（P〈0．01）。结论：氩离子凝固术治疗隆起糜烂性胃炎安全性好、疗效确切，有较高的临床应用价值。     

氩离子凝固术联合药物治疗Barrett食管的临床研究

目的探讨内镜下氩离子凝固术(argon plasma coagulation,APC)联合药物治疗Barrett食管(Barrett's esophagus,BE)的疗效。方法将90例BE患者按随机数字表法分为对照组和试验组各45例,试验组先给予单纯药物治疗8周(雷贝拉唑20 mg,bid,莫沙比利5 mg tid,铝碳酸镁片1 g tid),停药4周后复查胃镜,BE病灶仍存在者再行APC,术后服上述同样药物治疗;对照组先胃镜下行APC,术后再给予同样药物治疗。对于一次治疗不能清除病灶的患者,4周后进行第二次清除,直至病灶消失。两组APC均在无痛胃镜、窄带成像(NBI)及透明帽辅助下完成。于术后6、12、24个月进行NBI辅助下胃镜复查,对其疗效及并发症进行评估。结果试验组在单纯药物治疗3个月后胃镜下BE病灶未见明显改变;随访24个月,试验组镜下保持完全清除的BE食管患者占APC治疗的97.8%,明显高于对照组的77.8%(P<0.05)。两组临床症状缓解率(93.3%,86.6%)比较,差异无统计学意义,术后均无严重不良反应。结论单纯药物治疗虽不能消除BE黏膜病理改变,但可以缓解症状,减少APC后复发;先药物治疗2个月,再联合无痛胃镜下NBI及透明帽辅助下APC治疗BE疗效显著,有良好的临床应用前景。     

内镜下氩离子凝固术治疗Barrett食管疗效的探讨

目的 探讨内镜下氩离子凝固术(APC)联合抑酸剂埃索美拉唑镁治疗Barrett食管的临床疗效.方法 对23例经病理证实的Barrett食管行内镜下氩离子凝固术(APC),治疗间隔为2周,直至病理证实复层鳞状上皮完全修复,术后给予抑酸剂埃索美拉唑镁20 mg/次,2次//d口服,共3个月,术后第6个月及1年进行内镜及组织学随访.结果 17例经1次APC根除,4例经2次APC根除,2例经3次APC根除,平均烧灼次数为1.3次.全部病例于治疗后6个月均获得治愈,4例于治疗后1年出现化生的柱状上皮黏膜岛,治疗总有效率为82.6%.7例出现剑突或胸骨后疼痛,经口服埃索美拉唑镁后症状缓解.结论 BE的内镜下APC联合抑酸剂埃索美拉唑治疗安全有效,但仍有一定比例的复发与残留.     

内镜分级治疗Barrett食管的临床价值探讨

目的:探讨内镜分级治疗Barrett食管(BE)的临床价值。方法:通过NBI内镜引导靶向活检,对BE病灶实施动态病理监测,早期识别特殊肠化生细胞(SIM)、低度异型增生(LGD)、高度异型增生(HGD)、原位癌等病变阶段,在内镜下实施氩离子凝固疗法(APC)、透明帽辅助内镜黏膜切除术(EMRC)、内镜黏膜下剥离术(ESD)分级治疗。结果:术后第6个月复发内镜BE6例,病理BE4例,应用APC治疗后消失;本组未见出血、穿孔、狭窄等并发症。结论:内镜下APC、EMRC、ESD分级治疗BE近期疗效好、并发症少,是一种安全、有效的干预手段。     

内镜下氩离子凝固术治疗成熟型疣状胃炎35例临床分析

目的探讨内镜下氩离子凝固术(APC)在成熟型疣状胃炎中的治疗价值。方法35例成熟型疣状胃炎患者行APC治疗,氩气流量设定为2L/min,功率40～60W,灼除所有疣状病灶。术后给予奥美拉唑治疗。1个月后随访及胃镜复查。结果35例共146枚成熟型疣状胃炎病灶经APC治疗灼除,治疗次数根据病灶大小决定,平均每枚病灶治疗时间为3.9s(2￣6s)。所有患者未出现出血、穿孔等并发症。随访发现31例患者(88.6%)临床症状消失,内镜显示隆起病灶平伏,黏膜炎症明显改善。4例(11.4%)黏膜炎症改善,但仍有消化道症状。结论内镜下APC治疗成熟型疣状胃炎是一种安全、有效的方法。     

氩离子凝固术联合抑酸治疗Barrett食管的临床研究

目的：探讨内镜下氩离子凝固术（APC）联合抑酸治疗对Barrett食管的临床疗效。方法：选择经内镜及病理确诊的Barrett食管患者40例,随机分为两组,治疗组21例,对照组19例,治疗组经内镜下APC治疗后联合埃索美拉唑20mg2次／日连续3月,对照组单用埃索美拉唑20mg2次／日连续3月,分别于3月、6月、12月对两组进行临床症状积分和内镜及病理随访。结果：两组治疗后3、6、12月临床症状积分缓解无明显差异性（P〈0．05）,但从内镜、病理随访的有效率来看,治疗组与对照组相比有显著差异性（P〈0．05）。结论：BE内镜下APC联合抑酸治疗能有效逆转Barrett上皮,是一种安全、有效的治疗方法。     

乌鲁木齐市Barrett食管的发病情况和内镜下特点临床意义的研究

目的：研究乌鲁木齐市 Barrett 食管（BE）的发病情况和内镜、临床特点及其与反流性食管炎（RE）的关系。方法根据2011年6月4日在重庆召开的全国第二届Barrett食管专题学术研讨会上制定的BE诊治共识作为诊断标准诊断BE,研究BE患者的内镜检出率、内镜下的表现、分型及病理检查结果,分析研究患者的性别、年龄、体重、身高、症状、幽门螺杆菌（Hp）感染情况及其与BE和RE的关系。结果检出BE患者人数为总胃镜检查人数的7.9%,男女之比为1.98∶1,平均年龄（44.6±13.4）岁。其中仅19.14%患者有典型的反流症状。BE内镜分型中短节段占83.85%,多为舌状、岛状这2种形状。食管活检组织病理诊断为肠化型占BE的25.31%,10.04%伴异型增生,Hp阳性率为40.37%。RE检出率为2.07%。0.66%的BE伴RE。BE和RE合并消化性溃疡发生率差异无统计学意义（P＞0.05）。结论乌鲁木齐市地区居民BE的患病率较高,多为短节段舌状或岛状,约1/3为肠化型,以中年男性多见,常无症状,部分伴异型增生。体重超重增加了BE的发病风险。Hp感染可能与BE和RE的关系均不密切。     

Barrett食道和Barrett食道腺癌的临床病理学研究

本文报告Ｂａｒｒｅｔｔ食道４２例，其中８例具有腺癌结构。内镜观察：食道粘膜上皮粗糙、糜烂、颗粒状增生、斑块状隆起、溃疡、粘膜充血或苍白。组织学观察：Ｂａｒｒｅｔｔ食道上皮有三种不同形态，其中胃底型上皮８例，交界型上皮１４例，特殊型上皮２０例，８例具有腺癌结构，特殊型上皮与腺癌结构间可见过渡形态。粘液组化染色观察：２０例特殊型上皮，ＨＩＤ（＋）１８例，８例具有腺癌结构的病例，ＡＢ、ＨＩＤ均呈不同程度的阳性。ＡｇＮＯＲ染色观察，Ｂａｒｒｅｔｔ食道三种上皮与食道腺癌平均每核含ＡｇＮＯＲ颗粒数相比均有非常显著的统计学差异（Ｐ＜０．０１）；观察结果提示：Ｂａｒｒｅｔｔ食道与食道腺癌关系密切，特殊上皮型Ｂａｒｒｅｔｔ食道可能是食道腺癌的癌前病变。     

Chromoendoscopy and magnification endoscopy in Barrett's esophagus

Chromoendoscopy and magnification endoscopy appear to be a valuable adjuncts for the detection and classification of BE. These techniques may also prove to be useful aids in surveillance protocols for identifying dysplastic epithelium or early cancer within a segment of BE. Ideally, the use of these techniques would enable the endoscopist to rule in or out the presence of IM and of dysplastic or cancerous epithelium by obtaining only a minimal number of targeted biopsy specimens, or potentially performing no biopsies at all. This could transform upper endoscopy into a much more effective screening and surveillance tool for BE. Several problems currently exist for the use of chromoendoscopy for BE. Results of studies reporting the accuracy of chromoendoscopy remain mixed,and are likely explained by the wide range of techniques and materials used in the investigations. Staining adds several steps, and likely several minutes, to an upper endoscopy. Staining within the esophagus is often patchy and uneven. In addition, poor spraying technique exaggerates the irregular uptake by the mucosa. There is a high false-positive rate when staining gastric-type epithelium and denuded epithelium. Areas of dysplasia or cancer may take up stain in an irregular manner, or may not stain at all. Chromoendoscopy is a relatively new technique in the management of BE and depends on the skill and experience of the endoscopist. Magnification, however, only allows the endoscopist to observe small areas of mucosa at a time, increasing the overall complexity and length of the procedure. The learning curve for this procedure is relatively short, however, and endoscopists can usually become proficient in the technique quickly. Currently, the greatest body of literature exists concerning the use of methylene blue for diagnosing BE. At the present time, chromoendoscopy and magnification endoscopy appear to be most beneficial in detecting IM in short segments of esophageal columnar-appearing mucosa. If used consistently by practicing physicians, the accuracy of biopsies for IM could be improved. If endoscopic ablative therapy for HGD and early adenocarcinoma becomes accepted, sensitive methods of detecting residual BE after ablation will be needed to help guide additional endoscopic therapy. Chromoendoscopy and magnification endoscopy could prove helpful in this setting. Further research in this field remains to be performed. As a first step, a uniform classification system for staining and magnification patterns should be devised. If investigators can reach a consensus, and validate classification, terminology, and pattern-types, future studies could be performed using "common and similar language." More controlled investigations with larger numbers of patients must be performed before tissue staining and magnification endoscopy become a part of the practicing endoscopist's armamentarium. The ultimate aims of chromoendoscopy and magnification endoscopy in the setting of BE are to show improved outcomes--namely, early detection of cancer and improved survival rates. These goals have not yet been realized and meeting them will require well-designed studies in the future.     

The definition of Barrett's esophagus

Recently, according to increasing gastroesophageal reflux disease (GERD), the patients with Barrett's esophagus (BE) are increasing. Since Barrett have reported cases of esophageal ulcers surrounding by columnar epithelium, the various criteria of the BE have been proposed. In 1998, practice guidelines for BE were developed under the auspices of the American College of Gastroenterology. They proposed that BE was a chance in the esophageal epithelium of any length that can be recognized at endoscopy, and confirmed to have intestinal metaplasia by biopsy of the tubular esophagus and excludes intestinal metaplasia of the cardia. Endoscopically, BE is determined, when 'gastric-appearing mucosa' or apparent 'columnar lined esophagus' is evident proximal to the esophagogastric junction. Histologically, BE has double muscularis mucosae, and contains a mixture cell types; gastric-fundic type epithelium, junctional type epithelium, and specialized columnar epithelium (SCE). Especially SCE is distinctive features of BE, available for diagnosis. On the other hand, BE is premalignant condition for the adenocarcinoma of the esophagus, therefore the features of the BE are researched to prevent and find out earlier development of adenocarcinoma. In this review, we referred to the definition of BE with some topics.     

Staging of early adenocarcinoma in Barrett's esophagus

The main goal in the staging of patients with early neoplasia arising in the context of Barrett's esophagus (BE) is to identify individuals who are eligible for endoscopic therapy and differentiate them from those who require surgical management. To make the proper patient selection a combined staging strategy consisting of endoscopy evaluation, endoscopic ultrasonography, and endoscopic mucosal resection is necessary. In this article, the authors summarize the evidence behind each different staging modality in the setting of early BE adenocarcinoma and propose a staging approach that helps to select patients who are suitable for endoscopic therapy.     

Small-bowel tumors diagnosed by wireless capsule endoscopy: report of five cases

Tumors of the small bowel, both benign and malignant, are relatively uncommon. As the symptoms are vague and conventional diagnostic tests are unsatisfactory, these tumors often present a clinical, radiological, and endoscopic challenge. We report here on five patients in whom small-bowel tumors were diagnosed using wireless capsule endoscopy. The indications for capsule endoscopy were: obscure gastrointestinal bleeding in four patients (one jejunal capillary hemangioma, one ileal hemangiosarcoma, and two jejunal gastrointestinal stromal tumors) and chronic abdominal pain in one patient (ileal carcinoid). Wireless capsule endoscopy, a new endoscopic method, promises to improve the diagnosis of deep small-bowel pathology.