食管上段胃黏膜异位内镜下合并症的研究

Study on complications of upper esophageal gastric mucosa under heterotopic endoscopy

摘要:

目的 研究食管上段胃黏膜异位（HGMUE）的内镜检出率、内镜下表现和合并症。方法 回顾性研究2019年1月－2020年6月该院消化内镜中心经电子食管胃镜检查且诊断为HGMUE的患者资料。分析HGMUE的检出率、内镜下表现和合并症。结果 51 326例接受胃镜检查的患者中，375例诊断为HGMUE，检出率为0.73%。内镜下主要表现为玫瑰色-橘红色的天鹅绒样斑块，与周围食管黏膜界限清楚，可有多个，且大小不一。内镜下合并症包括：内镜阳性的胃食管反流病75例（20.00%），其中反流性食管炎44例（11.73%）、Barrett食管26例（6.93%）、两者合并存在5例（1.13%）；糜烂性胃炎56例（14.93%）；息肉54例（14.40%），其中胃息肉47例（12.53%）、十二指肠球部息肉7例（1.87%）；消化性溃疡42例（11.20%），其中十二指肠球部溃疡21例（5.60%）、胃溃疡17例（4.53%）、两者合并存在4例（1.07%）；恶性肿瘤9例（2.40%），其中胃癌3例（0.80%）、食管癌6例（1.60%），无合并症的HGMUE 139例（37.06%）。结论 HGMUE合并酸相关性疾病较为常见；合并上消化道恶性肿瘤尤其是食管恶性肿瘤的占比较高，这可能是上消化道肿瘤的预警因子之一，应予以重视。

Abstract:

Objective To investigate the incidence of heterotopic gastric mucosa in upper esophagus (HGMUE), and study the endoscopic manifestation and comorbidity of HGMUE.Methods A retrospective study was made among patients who underwent esophago-gastroduo-denoscopy and diagnosed with HGMUE from January 2019 to June 2020.Results Of the 51 326 patients who underwent EGD, 375 were diagnosed with HGMUE (0.73%). HGMUE are a velvety mucosa that is rosiness-orange in color, well-circumscribed in area, variable in quantity and size. Endoscopic complications include: gastroesophageal reflux disease with positive endoscopic image (n = 75, 20.00%) which included reflux esophagitis (RE, n = 44, 11.73%), Barrett’s esophagus (BE, n = 26, 6.93%), RE and BE coexists (n = 5, 1.13%); Erosive gastritis (n = 56, 14.93%); Polyps (n = 54, 14.40%) which included gastric polyps (n = 47, 12.53%) and duodenal polyps (n = 7, 1.87%). The forth was peptic ulcer (n = 42, 11.20%) which included duodenal ulcer (DU, n = 21, 5.60%), gastric ulcer (GU, n = 17, 4.53%), GU and DU coexists (n = 4, 1.07%); Malignancy (n = 9, 2.40%) which included gastric carcinoma (n = 3, 0.80%) and esophageal carcinoma (n = 6, 1.60%). HGMUE without endoscopic complications (n = 139, 37.06%).Conclusion Acid related diseases were common comorbidities of HGMUE. Since a relatively high prevalence of malignancy, especially esophageal malignancy was found as comorbidity of HGMUE, it could be a warning factor for malignancy.