Abstract:
:Barrett esophagus (BE) is considered the precursor for nearly all cases of esophageal adenocarcinoma. The potential sequence from intestinal metaplasia to dysplasia to cancer can best be monitored by careful endoscopic observation and surveillance biopsies. The ability to diagnose BE, biopsy accurately, and appropriately monitor are requisites for all who care for patients with this disorder. The normal endoscopic anatomy of the esophagogastric junction region and the changes that are associated with BE are discussed. The relationship of the squamocolumnar mucosal junction to the proximal margin of the gastric folds and the distal extent of the linear esophageal vessels is the principal landmark for diagnosis. Chromoendoscopy with methylene blue and Lugol iodine will enhance endoscopic observation, thereby allowing directed biopsies. Biopsy forceps and technique are reviewed along with the when and where for surveillance biopsies. Since most dysplasia and intramucosal cancer is focal and invisible to the endoscopist, it is easy to understand why the sampling error exceeds 95% using a standard four-quadrant biopsy protocol. Currently, this sampling error can be reduced by four-quadrant biopsies at closer intervals and biopsies of even the most minor focal abnormalities of mucosa in the BE segment. Screening may be enhanced in the future depending upon successful development of new cytologic, spectrographic, and tomographic methods capable of identifying foci of dysplasia or cancer that can be confirmed by targeted biopsies.
journal_name
J Clin Gastroenteroljournal_title
Journal of clinical gastroenterologyauthors
Boyce HWdoi
10.1097/00004836-200305001-00003subject
Has Abstractpub_date
2003-05-01 00:00:00pages
S6-18; discussion S26-8issue
5 Suppleissn
0192-0790issn
1539-2031journal_volume
36pub_type
杂志文章,评审abstract::A case of an ulcerated gastric wall mass ultimately found to be splenosis is presented in which the index patient had endoscopic and endoscopic ultrasonographic evaluation prior to resection. Although no visual features identified this mass as a splenic implant preoperatively, the lesion appeared to be atypical for le...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-199904000-00020
更新日期:1999-04-01 00:00:00
abstract::We report a 29-year-old woman with a 20-year history of Crohn's disease and neutropenia. Because of repeated complications of Crohn's disease, she has undergone three intestinal resections and also has had recurrent skin abscesses, sinusitis, and pneumonia. Persistent neutropenia has been noted throughout the course o...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-199106000-00016
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journal_title:Journal of clinical gastroenterology
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1996-07-01 00:00:00
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
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journal_title:Journal of clinical gastroenterology
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abstract::Pneumocystis carinii infection of the liver is being reported with increasing frequency in patients with acquired immune deficiency syndrome (AIDS). The clinical picture typically resembles hepatitis. We report such an occurrence in a patient with persistent elevation of alkaline phosphatase and gamma-glutamyl transpe...
journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,评审
doi:10.1097/00004836-199207000-00013
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-199907000-00011
更新日期:1999-07-01 00:00:00
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,评审
doi:10.1097/00004836-200207001-00010
更新日期:2002-07-01 00:00:00
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,评审
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
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更新日期:1993-07-01 00:00:00
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,多中心研究
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更新日期:2008-03-01 00:00:00
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journal_title:Journal of clinical gastroenterology
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journal_title:Journal of clinical gastroenterology
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更新日期:2003-04-01 00:00:00
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章,评审
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journal_title:Journal of clinical gastroenterology
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journal_title:Journal of clinical gastroenterology
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journal_title:Journal of clinical gastroenterology
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journal_title:Journal of clinical gastroenterology
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journal_title:Journal of clinical gastroenterology
pub_type: 临床试验,杂志文章,meta分析
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-198504000-00009
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journal_title:Journal of clinical gastroenterology
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
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更新日期:1996-10-01 00:00:00
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-199203000-00017
更新日期:1992-03-01 00:00:00
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
doi:10.1097/00004836-198808000-00016
更新日期:1988-08-01 00:00:00
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journal_title:Journal of clinical gastroenterology
pub_type: 杂志文章
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更新日期:2009-07-01 00:00:00