San Diego - Txawm hais tias muaj ntau qhov kev rau siab rau kev txhim kho qhov zoo hauv kev tshawb xyuas endoscopy nyob rau kaum xyoo dhau los lossis yog li tau tsom mus rau colonoscopy, nws yuav yog lub sijhawm los tig mus rau sab sauv endoscopy-tshwj xeeb, txo qis tus nqi tom qab-endoscopy Barrett's neoplasia.
"Ib yam li cov kab mob hauv plab tuaj yeem ploj mus tom qab colonoscopy, Barrett's neoplasia tuaj yeem ploj mus tom qab kev kho mob sab saud. Peb paub tias cov qog nqaij hlav thiab neoplasias tau ploj mus ntawm qhov ntsuas qhov ntsuas qhov ntsuas," Prateek Sharma, MD, hais.Gastroenterology & Endoscopy Xov Xwm.
Thaum lub sij hawm American Society for Gastrointestinal Endoscopy (ASGE) postgraduate course at the 2022 Digestive Disease Week, Dr. Sharma, xib fwb ntawm cov tshuaj ntawm University of Kansas School of Medicine, nyob rau hauv Kansas City, piav qhia post-endoscopy Barrett's neoplasia (PEBN), vim li cas nws tseem ceeb, thiab ntsuas endoscopists tuaj yeem siv los ua kom lawv lub peev xwm los txheeb xyuas cov kab mob me me no.
"Thaum cov neeg mob raug xa mus rau ib lub chaw tertiary tom qab random biopsy qhia tau tias qib siab neoplasia lossis mob qog noj ntshav, 75 feem pua lossis ntau dua ntawm lub sijhawm tertiary center endoscopist pom qhov mob thawj zaug endoscopist tsis pom," said Nicholas J. Shaheen, MD, tus thawj coj ntawm Division of Gastroenterology thiab Hepatology ntawm University of North Carolina ntawm Chapel Hill's School of Medicine. "Qhov no yog ib feem ntawm qhov chaw endoscopist tertiary center muaj qhov zoo dua-paub txog ib yam dab tsi tau pom ntawm qhov seemingly random biopsy. Tab sis ib feem ntawm nws, undoubtedbly, yog tias qhov mob ib txwm muaj thiab tsuas yog tsis lees paub," Dr. Shaheen hais.Gastroenterology & Endoscopy Xov Xwm. "Yog li, peb paub tias qhov no yog qhov teeb meem tiag tiag."
Defining PEBN, Tsim Kev Ntsuas Zoo
Lub ntsiab lus ntawm PEBN yog ua raws li cov kab mob qog noj ntshav tom qab colonoscopy uas tsim los ntawm World Endoscopy Organization: ib qho kab mob neoplastic kuaj pom rau lub hlis tom qab qhov ntsuas qhov ntsuas endoscopy.
"Qhov no tuaj yeem yog vim muaj ntau yam, suav nrog kev ploj mus," Dr. Sharma tau hais.
Hauv kev tshuaj ntsuam xyuas meta uas kuaj xyuas tus nqi ntawm PEBN tom qab pib qhov tsis zoo endoscopy (txhais cov kab mob kuaj pom ntawm thawj qhov kev kuaj mob los yog nyob rau hauv rau lub hlis raws li Barrett's neoplasia, qhov mob kuaj pom ntawm xya lub hlis thiab peb xyoos tom qab qhov ntsuas endoscopy li PEBN, thiab ib qho neoplasia pom 36 lub hlis lossis ntau dua tom qab kuaj thawj zaug tsis zoo li qhov xwm txheej lossis tshiab), cov kws tshawb fawb pom tias cov qeb loj tshaj plaws yog cov neoplasia (Endoscopy2022 Lub Ib Hlis 3. doi: 10.1055/a-1729-8066).
"Qhov no qhia peb tias thawj qhov kev tshuaj ntsuam xyuas koj ua rau cov neeg mob BE yog tej zaum koj qhov tseem ceeb tshaj plaws endoscopy - qhov no yog qhov koj yuav kuaj pom cov kab mob neoplastic feem ntau," Dr. Sharma tau hais, sau tseg tias feem pua ntawm cov neeg mob uas muaj neoplasia ntawm lawv qhov Performance index endoscopy tau nce ntau dua 30 xyoo dhau los.
Nws tau npaj ob qho kev ntsuas zoo rau kev kuaj mob endoscopy hauv cov neeg mob BE. Thawj yog siv sijhawm txaus los tshawb nrhiav qhov txhab. "Nco ntsoov tias koj tsis txaus siab rau koj li 60- qhov thib ob sab sauv endoscopy, vim hais tias qhov endoscopy sab sauv yog qhov tseem ceeb sib npaug li kev kuaj ntshav." Qhov kev ntsuas thib ob yog ntsuas koj qhov kev kuaj pom rau qib siab dysplasia thiab mob qog noj ntshav ntawm qhov ntsuas qhov ntsuas endoscopy kom paub tseeb tias koj tau ntsib cov qib uas cuam tshuam txog kev kuaj xyuas zoo. Raws li kev txheeb xyuas meta-kev soj ntsuam ntawm qhov sib koom ua ke ntawm qib siab dysplasia (HGD) thiab esophageal adenocarcinoma (EAC) ntawm qhov ntsuas endoscopy, qhov kuaj pom tus nqi yog kwv yees li 7 feem pua, txij li 4 feem pua rau 10 feem pua (Lub plab 2019;68[12]:2122-2128).
"Yog li, tsawg kawg ntawm ib lub tsev kawm ntawv qib siab, koj tuaj yeem siv qhov no los saib seb koj puas kuaj mob siab txaus dysplasia thiab mob qog noj ntshav ntawm koj qhov Performance index endoscopy," Dr. Sharma hais.
Txhim kho kev lees paub ntawm Barrett's Neoplasia
Kev soj ntsuam zoo siab yuav tsum tau soj ntsuam xyuas kom zoo, ua qauv tsim nyog thiab kev lees paub tsim nyog, Dr. Sharma tau hais.
Koj yuav tsum siv sijhawm npaum li cas rau kev kuaj mob endoscopic? Kwv yees li ib feeb ib centimeter ntawm Barrett's esophagus (BE), raws li kev tshawb fawb tsis ntev los no (Mob plab Endosc2012;76[3]:P531-P538). "Qhov kev kawm zoo nkauj no tau pom tias ntau lub sijhawm koj siv sijhawm tshuaj xyuas Barrett ntu, koj yuav pom HGD thiab EAC ntau dua," Dr. Sharma tau hais.
"Nws yog ib qho tseem ceeb rau kev cob qhia koj tus kheej thiab koj ob lub qhov muag," nws hais ntxiv. "Kev paub qhov txhab yog tus yuam sij rau kev txhim kho koj qhov kev kuaj mob neoplasia."
Tom qab kuaj xyuas, ua raws Seattle raws tu qauv rau kev kuaj pom zoo. "Dab tsi peb ib txwm nco ntsoov hauv Seattle raws tu qauv yog tias nws suav nrog thawj lub hom phiaj biopsies, tom qab ntawd cov biopsies random. Lub hom phiaj biopsies tseem ceeb heev. Nco ntsoov cov lus hais, 'saib ntau, biopsy tsawg' -vim yog tias koj saib ntau dua, koj yuav pom. lub hom phiaj lesion," Dr. Sharma hais.
Kuj tseem ceeb yog qhov tsim nyog paub txog neoplasia, tab sis qhov no tuaj yeem ua kom yuam kev (Daim duab). Virtual chromoendoscopy nqaim band imaging, xiav lub teeb pom kev zoo thiab cov duab txhim kho i-SCAN (Pentax Medical) tuaj yeem yog cov cuab yeej siv tau zoo, tab sis tus kws endoscopist xav paub seb lawv tab tom nrhiav dab tsi, thiab qhov no yuav xav tau kev cob qhia ntxiv.
Tau txais kev txawj ntse, Dedicating kws txawj
"Kuv xav tias, feem ntau, kev nrhiav tau cov txuj ci endoscopic rau cov kws kho mob tsis khoom yog qhov nyuaj me ntsis. Zoo hmoo, cov koom haum tau sim ntau yam los pab cov kws kho mob endoscopists tau txais kev txawj ntse raws li qhov kev lag luam tau nce siab," Dr. Shaheen tau hais..
Raws li qhov piv txwv, ASGE muaj nws cov Kev Txawj Ntse, Kev cob qhia thiab Kev Ntsuam Xyuas, cov chav kawm nyob nrog kev cob qhia ntawm lawv qhov chaw hauv Downers Grove, Ill. daim ntawv pov thawj uas qhia tau hais tias koj tau kawm qib siab hauv cheeb tsam ntawd, "Dr. Shaheen tau hais.
Tshwj xeeb rau BE, muaj International Working Group for Classification of Oesophagitis BORN (BE-related neoplasia) program, ib qho kev qhia hauv web rau endoscopic lees paub ntawm qhov txhab. Nyob rau hauv 2019, Bergman thiab al luam tawm kev tshawb fawb qhia qhov kev cob qhia tau txhim khu kev qha endoscopists '"nrhiav thiab delineation ntawm neoplastic lesions" (Gastroenterology2019;156[5]:1299-1308).
Nyob rau hauv ib tug randomized tswj mus sib hais, Dr. Sharma thiab nws cov co-xav soj ntsuam kuj qhia tau txhim khu kev qha raws li Seattle biopsy raws tu qauv thiab "kev paub txog BE nrhiav thiab kev ntsuam xyuas" ntawm endoscopists uas underwed ib qho kev kawm intervention piv nrog rau cov uas tsis tau txais kev cob qhia no (Gastrointest Endosc2022;95[2]:239-245).
Dr. Shaheen tau lees paub tias txawm hais tias ntau txhiab tus kws kho mob gastroenterologist tuaj koom kev kawm kho mob txuas ntxiv txhua xyoo txhawm rau txhim kho lawv cov kev txawj ntse hauv cov chav kawm, kev cob qhia tshwj xeeb tsis yog qhov yuav tsum tau ua, thiab cov peev txheej no tsis siv tau rau txhua tus. "Tsuas muaj ntau teev hauv ib hnub thiab ntau yam uas koj tuaj yeem dhau los ua tus kws tshaj lij," Dr. Shaheen tau hais. "Tab sis kuv xav tias peb muaj lub sijhawm, vim tias pawg GI tau loj dua, txawm tias nyob rau hauv kev coj ua ntiag tug, txhawm rau txheeb xyuas ib lossis ob tus kws kho mob endoscopists uas tuaj yeem mob siab rau lawv tus kheej kom muaj kev paub zoo hauv kev tshawb nrhiav Barrett's neoplasia, ib yam li peb muaj cov kws tshaj lij. ERCP thiab EU."
Rau cov qauv ntawm cov duab suav nrog qhia qhov chaw ntawm BE lesions, saib, "Koj puas pom Barrett's Neoplasia?"los ntawm peb qhov teeb meem lub Cuaj Hli.
- Monica J. Smith
Dr. Sharma qhia txog kev sib raug zoo nyiaj txiag nrog Bausch, Boston Scientific, CDx, Cosmo, Docbot, Erbe USA, Fujifilm, Ironwood, Lumendi, Medtronic, Olympus thiab US Endoscopy. Nws yog ib tug tswv cuab ntawm Gastroenterology & Endoscopy News editorial board. Dr. Shaheen qhia txog kev sib raug zoo nyiaj txiag nrog Aqua Medical, CDx, Cernostics, Cook, Exact Sciences, Interpace, Lucid, Medtronic, Pentax, Phathom thiab Steris.
