| 抄録 |
Introduction: In patients with SSBE, surveillance endoscopy is also recommended, although an appropriate surveillance method remains controversial. We have previously shown that the pit pattern diagnosis by image-enhanced endoscopy (IEE) including crystal violet (CV) chromoendoscopy can detect dysplastic lesions in Barrett's esophagus (BE) with high sensitivity and specificity. In this study, we evaluated the effectiveness of IEE surveillance for SSBE regarding a malignant potential.Methods: 355 biopsy samples with histologically proven BE in 209 SSBE patients (125 males, 84 females) were enrolled. Mucin-phenotyping; expression of fatty acid synthase (FASn), COX-2, and stromal angiogenesis; cellular proliferation; apoptosis were evaluated, and factors influencing mucosal pit pattern were determined by logistic multivariate analysis. All the patients were surveyed by CV-chromoendoscopy and narrow band imaging (NBI) endoscopy, and the pit and capillary patterns were classified into the following two types: closed and open, net or others.Results: In CV-chromoendoscopy, open type of pit pattern was observed in 70 out of 209 (33.5%). Presence of intestinal mucin-phenotype, COX-2 expression, FASn expression, enriched angiogenesis, accelerated cellular proliferation and inhibited apoptosis were confirmed to be positive independent factors for the expression of open type of pit pattern. In NBI endoscopy, the net pattern was conversely the negative predictor.Conclusion: Open type of pit pattern or non-net capillary patterns were closely related with a high malignant potential of BE, suggested that IEE is effective in SSBE surveillance. |
