Endoscopic, Histological Diagnosis And Argon Plasma Coagulation For Treatment Of Barrett's Esophagus

Background and Aims:Adenocarcinoma in the distal part of esophagus is increasing in incidence in west countries, as the precancerous lesion of esophageal adenocarcinoma, Barrett's esophagus(BE) should be thought much of. BE is the replacement of the squamous mucosa by metaplastic columnar lined glandular epithelium, and it is looked as a complication of chronic gastroesophageal relux disease,but the diagnosis and therapy is not so easy.In this study, our aims include:(1) To explore the role of the microstructural changes and the expression of the intestinal marker CDX2 in the diagnosis of Barrett's esophagus; (2) to differentiate Barrett's mucosa from cardiac intestinal metaplasia (CIM) and heterotopic gastric mucosa(HGM) of the esophagus; (3) to explore the clinical effect of endoscopic argon plasma coagulation(APC) and acid suppression for treatment of BE.Methods: (1) Mucosal patterns of 152 patients with Barrett's esophagus who undergoing upper digestive tract endoscopy in the period from February 2004 to September 2005 were studied. An high-resolution magnification endoscope (Olympus GIF-H260) was used. 60 patients with gastroesophageal reflux disease(GERD) were chosen as controls. All patients had no other diseases such as tumor and ulcer. Biopsy samples were taken from the magnified sites and gastric antrum,and specimens were fixed in 10% buffered formalin or snap-frozen and stored in -800C refrigeratory until assayed. Then Hematoxylin-eosin (HE) staining was used for the histopathological diagnosis.Traditional mucin histochemistry using periodic acid Schiff/alcian blue method was performed. CDX2 protein was detected by immunohistochemical staining and mRNA was detected by RT-PCR from 48 BE samples and 60 controls .The magnification endoscopic patterns were compared with histopathological results , immunohistochemical results and RT-PCR results. Chi-square analysis was carried out to test the significance. (2) the same 152 BE patients as above, 52 patients with HGM of the upper esophagus and 37 patients with CIM were studied.The same magnification endoscope was used and biopsies were taken from the lesions and gastric antrum, 30 patiens without distinct lesions in...