The Clinical Analysis Of 62 Cases Short-segment Barrett's Esophagus

Objective:To investigate the diagnostic value of Lugol's chromoendoscopy and use of argon plasma coagulation (APC) in treatment of short-segment Barrett's Esophagus(SSBE).Method:1. Sixty-two patients with endoscopy-proven SSBE were included to detect the length and shape of BE and reflux esophagitis (RE) or esophageal hiatal hernia as well. 2-4 block biopsies from four-quadrant with 1-2cm intervals were taken and stained by iodine. According to Mori standard, the degree of stained colour was divided into four grades:â… , deeply stained;â…¡, normal brownish green or brown colour;â…¢, slightly stained;â…£, unstained. Shape and structural change after staining were observed carefully. Then another 2-4 biopies inâ…¢andâ…£stained area were taken for pathological examination.2. Clinical data of patients, including records of the age, sex, symptoms, course, intestinal metaplasia, dysplasia and other pathological data before and after staining were collected.3. All patients took PPI orally. Argon plasma coagulation was carried out in 20 cases. All patients were experienced by 2-8 month follow-up and records of endoscopic and pathological information were collected.4. Statistical data was processed by a SPSS13.0 package. Chi square test was used. P value of less than 0.05 was considered as significant.Results:1. SSBE occured mainly in males. The ratio of male to female was 1.7:1. 49 of 62 patients had the age of >45 years (79.0%). The average age was 48.3 years-old. About 85% of the patients have one or more symptoms of GERD.2. The island pattern was most common type which accounted for 66.1% of all types. Lugol's chromoendoscopy revealed 51 patients with gradeâ…¢staining among which 2 had moderate dysplaisa and 11 patients with gradeâ…£staining which had different degrees of dysplasia. 4 patients with gradeâ…¢-â…£had staining area of more than 1.0 cm in diameter, among which 3 patients were associated with moderate-severe dysplasia, 1 early esophageal adenocarcinoma. 58 patients had staining area of 0.5-1.0 cm in diameter. In 5 patients with irregular and beak-like tip staining shape, 4 had moderate-severe dysplasia and 1 had early esophageal adenocarcinoma. 35 patients had staining area with regular and knife-cut edge. 11 patients were associated with island-like deep staining in gradeâ…¢-â…£area which were proven pathologically as chronic inflammation or scar tissue.3. There were significant differences in the rates of specialized intestinal metaplasia (11.3% vs 27.4%, P<0.05) and dysplasia (6.5% vs 19.4%, P<0.05) before and after staining.4. APC combined with acid suppression was carried out in 25 cases, and recurrence of SSBE was found in 1 patient (4%) based on follow-up of 2-4 months and 3 (12%) based on follow-up of 6-8 months. 31 patients were given by oral administration of PPI. After 2-8 months endoscopic follow-up, 3 of 31 (9.7%) developed with shrinkage of BE. 1 patient with severe dysplasia were performed mucosa resection treatment by endoscopy and 1 patient with esophageal adenocarcinoma ofâ…¡c stage were performed surgical operation.Conclusion: SSBE may have a higher incidence of specialized intestinal metaplasia and dysplasia. Lugol's chromoendoscopy is of great importance in the diagnosis of SSBE, differenciation of dysplaisa and early detection of esophageal adenocarcinoma based on degree, dimention and edge alteration of iodine staining. Argon plasma coagulation is a secure and simple treatment for SSBE and its complications were rare. The recent effect of therapy is prominent whereas surveillance of relapse still needs to be paid attention to.