الفهرس Only 14 pages are availabe for public view
 |  | from | 203 |  |  |
| | | from | 203 | | |
Abstract
Tha nguoi dung noi se yeu minh toi mai thoi thi gio day toi se vui hon. Gio nguoi lac loi buoc chan ve noi xa xoi, cay dang chi rieng minh toi... http://nhatquanglan.xlphp.net/ BE is easily identified endoscopically, and the diagnosis confirmed by biopsy through the presence of specialized intestinal metaplasia (SIM) in the esophagus, regardless of the length of BE. The American College of Gastroenterology recommends routine surveillance endoscopy for patients with BE because of the increased risk of these patients developing cancer. On the basis of these recommendations, the current standard of care has been established. All persons with a history of chronic gastroesophageal reflux symptoms, even if they are controlled by medical therapy, should have at least a onetime upper endoscopy beginning at the age of 50- to screen for the presence or absence of BE. If BE is confirmed, the patient should have two surveillance endoscopies (four quadrant biopsies, 2 cm apart throughout the Barrett’s epithelium) 1 year apart. If no dysplasia is detected in either endoscopy, endoscopies should be repeated at 3-year intervals. If low grade dysplasia is detected, surveillance should be performed at 1-year intervals. If high grade dysplasia (HGD) is detected and confirmed by a second expert pathologist and is multifocal (defined as involving five or more crypts), and intervention is indicated.
There are three primary options once multifocal HGD has been confirmed. Patients can undergo aggressive surveillance endoscopy using the Seattle protocol (four quadrant biopsies using jumbo biopsy forceps at 1 cm intervals and biopsy of any mucosal irregularity with a therapeutic endoscope) at 3 month intervals until cancer is identified, or esophagectomy or ablative therapy can be performed. Continued surveillance using the Seattle protocol is largely reserved for poor surgical candidates. Ablation using photodynamic therapy (PDT) is a welcome alternative to esophagectomy for most patients, because esophagectomy is a highly morbid surgery even in expert centers with a mortality approaching 5%.