Leiper K, Morris A I
Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, United Kingdom.
Endoscopy. 2002 Feb;34(2):139-45. doi: 10.1055/s-2002-19858.
The incidence of oesophageal adenocarcinoma continues to rise rapidly in the West whereas cancer of the stomach is becoming less common. Most patients present with advanced disease that is not amenable to curative treatment. This review focuses on recent evidence on the endoscopic therapy of oesophago-gastric cancer. Although there are many treatment modalities available, there is a paucity of good quality randomised trial evidence on which to base palliative treatment decisions. Furthermore, although palliation of dysphagia may be improved by expandable metal stents or ablative therapy, there is no evidence that this improves survival and each of these therapies has a high frequency of complications particularly in longterm survivors. Exciting developments have however been reported in the therapy of early stage oesophago-gastric cancer. Endoscopic mucosal resection is particularly promising with high rates of complete removal of early cancer or high grade dysplasia. Long-term follow up of these patients is required because of high rates of metachronous tumour formation and at present there are no randomised trial data comparing endoscopic mucosal resection with conventional surgery.
在西方，食管腺癌的发病率持续快速上升，而胃癌则变得不那么常见。大多数患者就诊时已处于晚期疾病阶段，无法进行根治性治疗。本综述聚焦于食管胃癌内镜治疗的最新证据。尽管有多种治疗方式可供选择，但缺乏高质量的随机试验证据来指导姑息治疗决策。此外，尽管可扩张金属支架或消融治疗可能改善吞咽困难，但没有证据表明这能提高生存率，且这些治疗方法都有较高的并发症发生率，尤其是在长期存活者中。然而，早期食管胃癌的治疗已报道了令人兴奋的进展。内镜黏膜切除术特别有前景，早期癌症或高级别异型增生的完全切除率很高。由于异时性肿瘤形成率高，需要对这些患者进行长期随访，目前尚无比较内镜黏膜切除术与传统手术的随机试验数据。
