1　食管癌的诊断原则

a.若内镜下未见病灶，即随访。若发现病灶，取活检评估病理情况。若病理为轻度异型增生，每3年随访1次；若病理为重度异型增生、原位癌、黏膜内癌及SM1，行内镜下治疗。如果内镜表现较活检病理结果更重，建议行精细内镜检查（包括放大内镜、NBI、染色等）以评估病变情况、决定诊治计划。

b.若存在洛杉矶分级诊断为B、C、D级别的食管炎，需先口服PPI（每日2次）8~12周后再行内镜下诊断。如果没有BE，可以终止内镜筛查。若病理诊断为BE不伴有异型增生，每隔3~5年再次行内镜检查及病理活检。若病理诊断为BE伴低级别上皮内瘤变，则需行内镜下治疗或每年行内镜检查并行每隔1cm行4点位活检。若病理诊断为BE合并高级别上皮内瘤变，则需行内镜下治疗或外科手术治疗。

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