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Acta Endoscopica

, Volume 23, Issue 4, pp 301–309 | Cite as

La surveillance endoscopique des endobrachyœsophages

  • M. Robaszkiewicz
Article
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Résumé

L’endobrachyœsophage ou œsophage de Barrett est une entité caractérisée par le remplacement de la muqueuse malpighienne de l’œsophage distal par une muqueuse de type glandulaire. Le principal risque évolutif de cette métaplasie est représenté par la dégénérescence en adénocarcinome. Les adénocarcinomes sur endobrachyœsophage sont généralement diagnostiqués à un stade évolué et leur pronostic pourrait en théorie être amélioré par un dépistage précoce. Une surveillance endoscopique des œsophages de Barrett est donc recommandée afin de dépister ces cancers à un stade infra-clinique potentiellement curable. La stratégie de surveillance classique consiste à détecter des lésions dysplasiques par des biopsies multiples régulièrement espacées de la muqueuse de Barrett. En effet, l’adénocarcinome apparaît à la suite de modifications architecturales successives de la muqueuse de Barrett, que l’on désigne sous le terme de filiation métaplasie, dysplasie, cancer. La dysplasie est unanimement considérée comme le précurseur de cancer sur endobrachyœsophage. Elle n’est cependant pas un critère idéal de prédiction du risque de transformation maligne, car l’interprétation d’une lésion dysplasique est subjective. Les variations d’interprétation entre différents observateurs ne sont pas négligeables lorsqu’il s’agit de différencier des lésions de dysplasie modérée de modifications inflammatoires et régénératives. D’autres marqueurs biologiques d’évolutivité de la muqueuse de Barrett, indicateurs d’un risque élevé de dégénérescence, ont été recherchés. Plusieurs études récentes suggèrent que la cytométrie en flux pourrait en complément de l’histologie, permettre l’identification d’un sous-groupe de patients à risque de cancer, devant donc bénéficier d’une surveillance endoscopique renforcée.

Mots-clés

adénocarcinome dysplasie endobrachyœsophage œsophage de Barrett population à risque de cancer 

Endoscopic surveillance of Barrett’s esophagus

Summary

Barrett’s esophagus is a condition in which abnormal columnar mucosa replaces the normal squamous epithelium of the distal esophagus. Barrett’s metaplasia predisposes to the development of esophageal adenocarcinoma. Adenocarcinomas arising in Barrett’s mucosa are usually high stage at the time of diagnosis and their prognosis could theoretically be improved by earlier detection. The goal of endoscopic surveillance for patients with Barrett’s esophagus is to detect esophageal neoplasms in an early pre symptomatic stage when cure is still feasible. Currently, the most effective screening method appears to be close endoscopic surveillance and biopsy to identify dysplasia. Adenocarcinomas arising in Barrett’s esophagus generally evolve through a series of progressively severe dysplastic changes. Therefore dysplasia is widely regarded as the precursor of invasive malignancy in Barrett’s mucosa. Unfortunately, dysplasia falls far short of being an ideal biomarker of malignant potential, because the interpretation of dysplasia is largely a subjective skill. There can be inter-observer disagreement in the grading of dysplasia, particularly when attempting to distinguish low grade dysplasia from reactive and regenerative changes. There is a lively interest in research into more sensitive and cost-effective methods to predict patients at highest risk.. Some available data suggest that the combination of histology and flow cytometry could probably identify a subset of patients with Barrett’s esophagus who might be candidates for more intensive endoscopic surveillance for the early detection of high grade dysplasia or adenocarcinoma.

Key-words

adenocarcinoma Barrett’s esophagus dysplasia endobrachyesophagus population at high risk for cancer 

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Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • M. Robaszkiewicz
    • 1
  1. 1.Service de GastroentérologieCentre Hospitalier Universitaire A. MorvanBrest CedexFrance

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